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General NPI Number Information
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NPI Number | 1215099510
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Entity Type | Organization
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Legal Business Name | KI BOIS COMMUNITY ACTION FOUNDATION
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 11/21/2013
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Provider Practice Location Address
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Address Line | 107 MCKINLEY ST
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City | EUFAULA
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State | OK
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Zip | 74432-3052
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Country | US
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Telephone | 918-689-3265
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Fax | 918-689-3359
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Provider Business Mailing Address
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Address Line | PO BOX 727
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City | STIGLER
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State | OK
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Zip | 74462-0727
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Country | US
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Telephone | 918-967-3325
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Fax | 918-967-8660
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/CEO
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Name | MR. R. CARROLL HUGGINS
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Credential |
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Telephone | 918-967-3325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 01-1372703
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License Number State | OK
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