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General NPI Number Information
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NPI Number | 1184978512
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Entity Type | Organization
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Legal Business Name | NATIONAL COMMUNITY DEV CORP OF OK
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 11/07/2012
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Provider Practice Location Address
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Address Line | 3115 S WINSTON AVE
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City | TULSA
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State | OK
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Zip | 74135-2028
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Country | US
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Telephone | 918-585-2233
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Fax | 918-585-2513
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Provider Business Mailing Address
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Address Line | 3115 S WINSTON AVE
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City | TULSA
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State | OK
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Zip | 74135-2028
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Country | US
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Telephone | 918-585-2233
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Fax | 918-585-2513
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JIM FLUEGEL
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Credential | PH.D.
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Telephone | 918-585-2233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 7669
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License Number State | OK
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