# CLETAS COTTAGE DAY TREATMENT CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTRAL OKLAHOMA FAMILY MEDICAL CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1386815215
- **Legal business name:** CENTRAL OKLAHOMA FAMILY MEDICAL CENTER
- **Authorized official:** MR. CASEY H ANSON (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (580) 925-8804

## Contact information

- **Practice address:** 220 SOUTH 5TH ST, NOBLE, OK 73068
- **Practice address phone:** (580) 925-3286
- **Practice address fax:** (580) 925-3924
- **Mailing address:** PO BOX 358, 527 WEST THIRD STREET, KONAWA, OK 74849
- **Mailing address phone:** (580) 925-3286
- **Mailing address fax:** (580) 925-3924

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 03/19/2008
- **Last updated:** 04/20/2008