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NPI Code Detail

MEDICARE: AREA YOUTH SHELTER INC

MEDICARE: AREA YOUTH SHELTER 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
1251B00000XCase Management AgencyOK

General Provider Information

NPI Number : 1518392356
Entity Type Code : Organization
Provider Name (Legal Business Name) : AREA YOUTH SHELTER INC
Provider Business Mailing Address
First Line : 901 W 18TH ST
Second Line :
City : ADA
State : OK
Zip : 74820-7423
Country : US
Telephone Number : 580-436-6130
Fax Number :
Provider Business Practice Location Address
First Line : 901 W 18TH ST
Second Line :
City : ADA
State : OK
Zip : 74820-7423
Country : US
Telephone Number : 580-436-6130
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : MR. JAMES G BEGIN
Credential :
Telephone Number : 580-436-6130
Provider Enumeration Date : 09/12/2013
Last Update Date : 09/12/2013

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Directions to “AREA YOUTH SHELTER INC ” Practice Location

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