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Organization
3C OLD FASHION BOARDING HOME
Active
Organization
3C OLD FASHION BOARDING HOME
Active
Other names
3C Old Fashion Boarding Home
Organization subpart
No
Provider details
NPI number
Authorized official
JVON COOK (OWNER)
(405) 567-7677
Entity
Organization
Contact information
Practice address
719 S JIM THORPE BLVD, NBU 1706, PRAGUE, OK 74864-3505
(405) 567-2280
(405) 567-2280
Mailing address
719 S JIM THORPE BLVD, NBU 1706, PRAGUE, OK 74864-3505
(405) 567-2280
(405) 567-2280
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
—
OK
Other
Enumeration date
01/15/2010
Last updated
01/15/2010
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