Healthcare Provider Details

I. General information

NPI: 1790884120
Provider Name (Legal Business Name): ALLEN BOWDEN SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7049 FRANKOMA RD
TULSA OK
74131-2018
US

IV. Provider business mailing address

7049 FRANKOMA RD
TULSA OK
74131-2018
US

V. Phone/Fax

Practice location:
  • Phone: 918-224-4440
  • Fax: 918-224-0617
Mailing address:
  • Phone: 918-224-4440
  • Fax: 918-224-0617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberR0042052
License Number StateOK

VIII. Authorized Official

Name: MS. LUCLIE M HENDRICKS
Title or Position: R.N.
Credential: R.N
Phone: 918-224-4440