MEDICARE: SUBSTANCE ABUSE FOUNDATIION FOR EDUCAITON

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	3245S0500X	Children's Substance Abuse Rehabilitation Facility	961	OK

General Provider Information

NPI Number	:	1801317821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUBSTANCE ABUSE FOUNDATIION FOR EDUCAITON

Provider Business Mailing Address
First Line	:	2500 MCGEE DR STE 102
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73072-6705
Country	:	US
Telephone Number	:	405-310-0150
Fax Number	:	405-573-9727

Provider Business Practice Location Address
First Line	:	1618 SE 59TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73129-7314
Country	:	US
Telephone Number	:	405-310-0150
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. MICHAEL WESLEY VAUGHN
Credential	:	LADC
Telephone Number	:	405-310-0150

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	06/29/2017

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