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General NPI Number Information
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NPI Number | 1649392457
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Entity Type | Organization
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Legal Business Name | EASTERN OKLAHOMA COUNTY TECHNOLOGY
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 4601 N CHOCTAW RD
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City | CHOCTAW
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State | OK
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Zip | 73020-9017
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Country | US
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Telephone | 405-390-4400
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Fax | 405-390-6637
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Provider Business Mailing Address
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Address Line | 4601 N CHOCTAW RD
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City | CHOCTAW
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State | OK
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Zip | 73020-9017
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Country | US
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Telephone | 405-390-9591
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Fax | 405-390-6639
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | DARYL A CRUSOE
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Credential |
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Telephone | 405-390-6603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | DC5505-5505
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License Number State | OK
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