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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