Healthcare Provider Details

I. General information

NPI: 1982808457
Provider Name (Legal Business Name): ALPHA II, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 N MAIN ST
TONKAWA OK
74653-1038
US

IV. Provider business mailing address

PO BOX 369
TONKAWA OK
74653-0369
US

V. Phone/Fax

Practice location:
  • Phone: 580-628-2539
  • Fax: 580-628-4316
Mailing address:
  • Phone: 580-628-2539
  • Fax: 580-628-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARIANNE R. GUTIERREZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 580-628-2539