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General NPI Number Information
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NPI Number | 1295071918
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Entity Type | Organization
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Legal Business Name | AVALON CORRECTIONS
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Dates
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Enumeration Date | 12/28/2012
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Last Update Date | 12/28/2012
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Provider Practice Location Address
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Address Line | 400 S. MAY
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City | OKLAHOMA CITY
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State | OK
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Zip | 73108
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Country | US
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Telephone | 405-232-8233
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Fax |
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Provider Business Mailing Address
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Address Line | 700 NE 18
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City | OKLAHOMA CITY
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State | OK
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Zip | 73105
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CASE MANAGER
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Name | DAVID DUPLISSIS
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Credential |
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Telephone | 405-850-4923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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