Healthcare Provider Details

I. General information

NPI: 1730203951
Provider Name (Legal Business Name): RED ROCK BEHAVORIAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4404 N. LINCOLN BLVD
OKLAHOMA CITY OK
73105
US

IV. Provider business mailing address

3915 NW 122ND ST APT C
OKLAHOMA CITY OK
73120-8209
US

V. Phone/Fax

Practice location:
  • Phone: 405-425-0333
  • Fax: 405-425-0312
Mailing address:
  • Phone: 405-514-4393
  • Fax: 405-425-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. TIFFANY QUINTILA RIDEAUX
Title or Position: PROGRAM ASSISTANT
Credential: BA
Phone: 405-425-0333