Organization
PROVIDENCE SERVICE CORPORATION OF OKLAHOMA
Active
Other names
Providence of Oklahoma
Organization subpart
No
Provider details
NPI number
Authorized official
BREEANN MARIE HOERNING (AR AND BILLING MANAGER)
(520) 747-6600
Entity
Organization
Contact information
Practice address
301 N HIGH ST, ANTLERS, OK 74523-2238
(580) 298-5779
(580) 298-5016
Mailing address
620 N CRAYCROFT RD, TUCSON, AZ 85711-1448
(520) 747-6600
(520) 747-6613
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100750190M
—
OK
Enumeration date
12/08/2006
Last updated
08/22/2020
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