Healthcare Provider Details

I. General information

NPI: 1235458571
Provider Name (Legal Business Name): TJS DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 05/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 NE 23RD ST
OKLAHOMA CITY OK
73121-2453
US

IV. Provider business mailing address

15808 ALLEGHENY DR
EDMOND OK
73013-8832
US

V. Phone/Fax

Practice location:
  • Phone: 405-427-4422
  • Fax: 405-427-2380
Mailing address:
  • Phone: 405-340-8283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number3245S0500X
License Number StateOK

VIII. Authorized Official

Name: MRS. LATONYA ANNETTE WILSON
Title or Position: OWNER
Credential: MASTER'S DEGREE
Phone: 405-822-9231