Organization
OCCIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DENEKA CAIN TIVE (EXECUDIRECTOR)
14059456230
Entity
Organization
Contact information
Practice address
2625 GENERAL PERSHING BOULEVARD, OKLAHOMA CITY, OK 73107
(405) 887-3190
Mailing address
2625 GENERAL PERSHING BOULEVARD, OKLAHOMA CITY, OK 73107
(405) 887-3190
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
Y000013649
OK
Other
Enumeration date
12/01/2015
Last updated
12/01/2015
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