=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881055267
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAINT ANDRE' BESSETTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2016
-----------------------------------------------------
Last Update Date | 03/14/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 655 WEST TEXAS
-----------------------------------------------------
City | OKARCHE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73762-0245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-263-4658
-----------------------------------------------------
Fax | 405-263-4718
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 245
-----------------------------------------------------
City | OKARCHE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73762-0245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-263-4658
-----------------------------------------------------
Fax | 405-263-4718
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. DEBBIE ESPINOSA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 405-263-4658
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------