Organization
EAGLE RIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA JANE WILLIS (PERSONNEL & COMPLIANCE OFFICER)
(405) 858-2821
Entity
Organization
Contact information
Practice address
1916 E PERKINS AVE, GUTHRIE, OK 73044-5804
(405) 282-8262
Mailing address
PO BOX 1182, GUTHRIE, OK 73044-1182
(405) 282-8232
(405) 282-3305
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
OK
Other
Enumeration date
07/11/2008
Last updated
04/12/2018
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