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General NPI Number Information
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NPI Number | 1083848592
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Entity Type | Organization
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Legal Business Name | ROSE ROCK RECOVERY CENTER
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 24919 S 4420 RD
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City | VINITA
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State | OK
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Zip | 74301-5529
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Country | US
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Telephone | 918-256-9210
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Fax |
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Provider Business Mailing Address
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Address Line | 24919 S 4420 RD
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City | VINITA
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State | OK
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Zip | 74301-5529
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Country | US
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Telephone | 918-256-9210
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Fax |
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Authorized Official
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Title or Position | ASSISTANT DIRECTOR
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Name | MRS. JUDITH KAY BECK
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Credential | LPC/LADC
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Telephone | 918-256-9124
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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 | 682
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 1867
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License Number State | OK
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