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General NPI Number Information
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NPI Number | 1679154009
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Entity Type | Organization
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Legal Business Name | MONTGOMERY CARE CENTER
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Dates
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Enumeration Date | 04/17/2021
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Last Update Date | 04/17/2021
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Provider Practice Location Address
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Address Line | 321 S BOSTON AVE STE 300
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City | TULSA
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State | OK
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Zip | 74103-3311
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Country | US
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Telephone | 720-472-1938
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Fax |
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Provider Business Mailing Address
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Address Line | 621 PARALLEL AVE
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City | KANSAS CITY
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State | KS
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Zip | 66101-1620
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Country | US
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Telephone | 720-472-1938
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DARRYL MONTGOMERY
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Credential |
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Telephone | 720-472-1938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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