Healthcare Provider Details

I. General information

NPI: 1053512251
Provider Name (Legal Business Name): NATIONAL COMMUNITY DEV CORP OF OK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 SO BOSTON SUITE ONE
TULSA OK
74119-4029
US

IV. Provider business mailing address

45 HARRISON AVE OA
BRANFORD CT
06405-3787
US

V. Phone/Fax

Practice location:
  • Phone: 918-585-2233
  • Fax: 918-585-2513
Mailing address:
  • Phone: 203-483-1670
  • Fax: 203-483-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN F VARONE
Title or Position: VP FINANCE
Credential:
Phone: 203-483-1670