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General NPI Number Information
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NPI Number | 1073766465
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Entity Type | Organization
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Legal Business Name | ALPHA 2
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 1608 N. MAIN ST
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City | TONKAWA
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State | OK
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Zip | 74653
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Country | US
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Telephone | 580-628-2539
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Fax | 580-628-4316
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Provider Business Mailing Address
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Address Line | 1608 N MAIN ST
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City | TONKAWA
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State | OK
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Zip | 74653-1038
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Country | US
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Telephone | 580-628-2539
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Fax | 580-628-4316
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KARI SCOTT
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Credential |
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Telephone | 580-628-2539
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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