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General NPI Number Information
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NPI Number | 1487837167
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Entity Type | Organization
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Legal Business Name | LAND OF HOPE
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 12/17/2007
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Provider Practice Location Address
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Address Line | 57523 MOCCASIN TRAIL ROAD
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City | PRAGUE
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State | OK
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Zip | 74864
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Country | US
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Telephone | 405-567-0054
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Fax |
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Provider Business Mailing Address
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Address Line | 57523 MOCCASIN TRAIL ROAD
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City | PRAGUE
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State | OK
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Zip | 74864
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Country | US
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Telephone | 405-567-0054
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE OFFICER
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Name | MRS. MARY ANN THORNTON
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Credential |
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Telephone | 405-567-0054
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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 |
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License Number State |
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