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NPI Code Detail

MEDICARE: CEDAR RIDGE HOSPITAL

MEDICARE: CEDAR RIDGE HOSPITAL
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 Facility322D00000XOK

General Provider Information

NPI Number : 1609193135
Entity Type Code : Organization
Provider Name (Legal Business Name) : CEDAR RIDGE HOSPITAL
Provider Business Mailing Address
First Line : 6501 NE 50TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73141-9118
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6501 NE 50TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73141-9118
Country : US
Telephone Number : 405-605-6111
Fax Number :
Authorized Official
Title or Position : MENTAL HEALTH TECHNICIAN
Name : MR. CHANDELL TYRONE BELL
Credential :
Telephone Number : 405-532-3872
Provider Enumeration Date : 04/23/2010
Last Update Date : 04/23/2010

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Directions to “CEDAR RIDGE HOSPITAL ” Practice Location

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