Organization
EAGLE RIDGE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN MAYFIELD M.DIV. (EXECUTIVE DIRECTOR)
(405) 840-1359
Entity
Organization
Contact information
Practice address
601 NE 63RD ST, OKLAHOMA CITY, OK 73105-6407
(405) 840-1359
Mailing address
601 NE 63RD ST, OKLAHOMA CITY, OK 73105-6407
(405) 840-1359
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
7272
OK
Other
Enumeration date
04/10/2012
Last updated
04/10/2012
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