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General NPI Number Information
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NPI Number | 1245401413
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Entity Type | Organization
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Legal Business Name | TRI-CITY SUBSTANCE ABUSE CENTER, INC.
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Dates
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Enumeration Date | 03/17/2008
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Last Update Date | 03/17/2008
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Provider Practice Location Address
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Address Line | 124 S BROADWAY AVE
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City | ADA
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State | OK
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Zip | 74820-5807
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Country | US
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Telephone | 580-332-8773
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Fax | 580-332-8774
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Provider Business Mailing Address
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Address Line | 124 S BROADWAY AVE
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City | ADA
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State | OK
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Zip | 74820-5807
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Country | US
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Telephone | 580-332-8773
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Fax | 580-332-8774
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. SHARON I KNOWLES
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Credential | CADC, CCS
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Telephone | 580-332-8773
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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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