Healthcare Provider Details

I. General information

NPI: 1962617563
Provider Name (Legal Business Name): TRI COUNTY ELDERLY NUTRITION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S COMMERCIAL 104 S COMMERCIAL
TEMPLE OK
73568-0000
US

IV. Provider business mailing address

104 S COMMERCIAL 104 S COMMERCIAL
TEMPLE OK
73568-0000
US

V. Phone/Fax

Practice location:
  • Phone: 580-342-5145
  • Fax: 580-342-6898
Mailing address:
  • Phone: 580-342-5145
  • Fax: 580-342-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: TARA M. BROWN
Title or Position: PROJECT DIRECTOR
Credential:
Phone: 580-342-5145