MEDICARE: FAMILY OPTIONS COMMUNITY BASED SERVICES

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	251S00000X	Community/Behavioral Health Agency	TEMP	OK

General Provider Information

NPI Number	:	1912282112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY OPTIONS COMMUNITY BASED SERVICES

Provider Business Mailing Address
First Line	:	2914 EPPERLY DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73115-3322
Country	:	US
Telephone Number	:	405-604-9790
Fax Number	:	405-702-7668

Provider Business Practice Location Address
First Line	:	2914 EPPERLY DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73115-3322
Country	:	US
Telephone Number	:	405-604-9790
Fax Number	:	405-702-7668

Authorized Official
Title or Position	:	CEO
Name	:	MR. LEE BROWN
Credential	:
Telephone Number	:	405-604-9790

Provider Enumeration Date	:	10/19/2011
Last Update Date	:	10/19/2011

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Directions to “FAMILY OPTIONS COMMUNITY BASED SERVICES ” Practice Location

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