Organization
WOODLAWN LP
Active
Other names
PROVIDENCE HOUSE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GREG MACHTOLFF (MANAGER)
(405) 282-2600
Entity
Organization
Contact information
Practice address
405 N 20TH ST, GUTHRIE, OK 73044-2103
(405) 282-1517
(405) 282-9007
Mailing address
PO BOX 977, GUTHRIE, OK 73044-0977
(405) 282-2600
(405) 282-2610
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
NH4208
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100771000A
—
OK
Enumeration date
08/16/2005
Last updated
09/08/2011
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