MEDICARE: SAFY OF OKLAHOMA - LAWTON

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	253J00000X	Foster Care Agency

General Provider Information

NPI Number	:	1376860551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFY OF OKLAHOMA - LAWTON

Provider Business Mailing Address
First Line	:	1320 NW HOMESTEAD DR
Second Line	:	SUITE G
City	:	LAWTON
State	:	OK
Zip	:	73505-5243
Country	:	US
Telephone Number	:	580-355-8883
Fax Number	:	580-355-8885

Provider Business Practice Location Address
First Line	:	1320 NW HOMESTEAD DR
Second Line	:	SUITE G
City	:	LAWTON
State	:	OK
Zip	:	73505-5243
Country	:	US
Telephone Number	:	580-355-8883
Fax Number	:	580-355-8885

Authorized Official
Title or Position	:	CPA SENIOR VP OF FINANCE
Name	:	MR. JOHN HOLLENKAMP
Credential	:
Telephone Number	:	419-695-8010

Provider Enumeration Date	:	04/27/2010
Last Update Date	:	04/27/2010

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