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General NPI Number Information
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NPI Number | 1184795338
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Entity Type | Organization
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Legal Business Name | FOUR WINDS RANCH RECOVERY CENTER FOR ADOLESCENT FEMALES L.L.C.
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 501 N SANTA FE RD
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City | GUTHRIE
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State | OK
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Zip | 73044-8982
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Country | US
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Telephone | 405-260-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 1405 N PIERCE ST STE 202
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City | LITTLE ROCK
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State | AR
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Zip | 72207-5349
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Country | US
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Telephone | 501-227-7305
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Fax | 501-227-4669
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Authorized Official
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Title or Position | PARTNER
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Name | JOHN NOVELLE
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Credential |
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Telephone | 501-227-7305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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