Healthcare Provider Details

I. General information

NPI: 1114279718
Provider Name (Legal Business Name): FAMILY AND CHILDREN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10922 E 39TH ST
TULSA OK
74146-2703
US

IV. Provider business mailing address

10922 E 39TH ST
TULSA OK
74146-2703
US

V. Phone/Fax

Practice location:
  • Phone: 918-313-5250
  • Fax:
Mailing address:
  • Phone: 918-313-5250
  • Fax:

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: JACK BRADBERRY
Title or Position: CASE MANAGER
Credential:
Phone: 918-378-0425