Healthcare Provider Details

I. General information

NPI: 1437198843
Provider Name (Legal Business Name): UNITED COMMUNITY ACTION PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 DENVER ST
PAWNEE OK
74058-3522
US

IV. Provider business mailing address

501 6TH ST
PAWNEE OK
74058-2542
US

V. Phone/Fax

Practice location:
  • Phone: 918-762-3686
  • Fax: 918-762-2617
Mailing address:
  • Phone: 918-762-3686
  • Fax: 918-762-2617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD E. JESTES
Title or Position: PROGRAM DIRECTOR
Credential: CADC
Phone: 918-762-3686