Organization
ALPHA 2
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARI SCOTT (EXECUTIVE DIRECTOR)
(580) 628-2539
Entity
Organization
Contact information
Practice address
1608 N. MAIN ST, TONKAWA, OK 74653
(580) 628-2539
(580) 628-4316
Mailing address
1608 N MAIN ST, TONKAWA, OK 74653-1038
(580) 628-2539
(580) 628-4316
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
10/29/2008
Last updated
10/29/2008
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