Healthcare Provider Details

I. General information

NPI: 1841577905
Provider Name (Legal Business Name): SPANISH COVE HOUSING AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 PALM AVE
YUKON OK
73099-5645
US

IV. Provider business mailing address

11 PALM AVE
YUKON OK
73099-5645
US

V. Phone/Fax

Practice location:
  • Phone: 405-354-1901
  • Fax:
Mailing address:
  • Phone: 405-354-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberCC09010901
License Number StateOK

VIII. Authorized Official

Name: MR. SHERMAN HUFF
Title or Position: EXECUTIVE ADMINISTRATOR/CEO
Credential:
Phone: 405-350-5000