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General NPI Number Information
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NPI Number | 1588179600
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Entity Type | Organization
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Legal Business Name | OKLAHOMA HOMES FOR THE DEVELOPMENTALLY DISABLED, LLC
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 10/25/2021
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Provider Practice Location Address
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Address Line | 209 E GARBER RD
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City | GARBER
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State | OK
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Zip | 73738-1039
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Country | US
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Telephone | 580-863-2200
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Fax | 580-863-2206
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Provider Business Mailing Address
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Address Line | PO BOX 366
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City | BILLINGS
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State | OK
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Zip | 74630-0366
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Country | US
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Telephone | 580-725-3400
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MELISSA FRUITS
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Credential |
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Telephone | 580-725-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | NH2403-2403
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License Number State | OK
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