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General NPI Number Information
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NPI Number | 1366644841
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Entity Type | Organization
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Legal Business Name | EDMOND ASSOCIATION OF RETARDED CITIZENS, INC.
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10 E 9TH ST
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City | EDMOND
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State | OK
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Zip | 73034-3911
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Country | US
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Telephone | 405-341-7132
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 268
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City | EDMOND
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State | OK
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Zip | 73083-0268
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Country | US
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Telephone | 405-341-7132
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BONNIE WELLS
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Credential |
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Telephone | 405-341-7132
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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 |
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License Number State |
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