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NPI Code Detail

MEDICARE: BRIGGS THERAPEUTIC INTENSIVE CHILD DEVOPMENT SERVICES INC.

MEDICARE: BRIGGS THERAPEUTIC INTENSIVE CHILD DEVOPMENT SERVICES INC.
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
1322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number : 1316228414
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIGGS THERAPEUTIC INTENSIVE CHILD DEVOPMENT SERVICES INC.
Provider Business Mailing Address
First Line : 425 FRETZ AVE STE E
Second Line :
City : EDMOND
State : OK
Zip : 73003-5568
Country : US
Telephone Number : 405-844-2992
Fax Number :
Provider Business Practice Location Address
First Line : 425 S FRETZ AVE STE E
Second Line :
City : EDMOND
State : OK
Zip : 73003-5568
Country : US
Telephone Number : 405-844-2992
Fax Number :
Authorized Official
Title or Position : TEACHER ASSISTANT
Name : CARINA MUN LAN BULOCK
Credential :
Telephone Number : 405-512-9000
Provider Enumeration Date : 09/01/2011
Last Update Date : 09/01/2011

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