Healthcare Provider Details

I. General information

NPI: 1174876312
Provider Name (Legal Business Name): YCO OF OKC, INC. D/B/A YOUTHCARE OF OKLAHOMA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E SHERIDAN AVE SUITE 2
OKLAHOMA CITY OK
73104-4233
US

IV. Provider business mailing address

222 E SHERIDAN AVE SUITE 2
OKLAHOMA CITY OK
73104-4233
US

V. Phone/Fax

Practice location:
  • Phone: 405-200-0124
  • Fax: 405-270-0543
Mailing address:
  • Phone: 405-200-0124
  • Fax: 405-270-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT LOBATO
Title or Position: CEO
Credential: MS, MPH
Phone: 405-222-8167