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General NPI Number Information
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NPI Number | 1447521885
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Entity Type | Organization
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Legal Business Name | CHILDRENS EECOVERY CENTER
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Dates
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Enumeration Date | 01/17/2012
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Last Update Date | 01/17/2012
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Provider Practice Location Address
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Address Line | 2220 S SANTA FE AVE APT 105
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City | MOORE
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State | OK
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Zip | 73160-2866
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Country | US
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Telephone | 405-664-0415
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 S. SANTA FE APT 105
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City | MOORE
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State | OK
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Zip | 73160
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Country | US
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Telephone | 405-664-0415
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JEFF SMITH
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Credential |
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Telephone | 405-364-9004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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