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General NPI Number Information
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NPI Number | 1932486909
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Entity Type | Organization
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Legal Business Name | C4C
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 34396 RIVER RD
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City | WHITESBORO
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State | OK
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Zip | 74577-1019
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Country | US
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Telephone | 918-413-2568
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Fax |
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Provider Business Mailing Address
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Address Line | 34396 RIVER RD
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City | WHITESBORO
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State | OK
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Zip | 74577-1019
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BHRS
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Name | MS. SONYA MORGAN
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Credential |
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Telephone | 918-413-2568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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