MEDICARE: NEW FRONTIERS ICFMR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	315P00000X	Intellectual Disabilities Intermediate Care Facility	NH566	OK

General Provider Information

NPI Number	:	1164591442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW FRONTIERS ICFMR

Provider Business Mailing Address
First Line	:	1400 N COUNCIL RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-4918
Country	:	US
Telephone Number	:	405-789-2262
Fax Number	:	405-789-3053

Provider Business Practice Location Address
First Line	:	6810 NW 11TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-4210
Country	:	US
Telephone Number	:	405-789-2262
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DON MOORE
Credential	:
Telephone Number	:	405-789-2262

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	08/22/2020

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