Organization
MID-DEL GROUP HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES LAWRENCE RAY (EXECUTIVE DIRECTOR)
(405) 732-8568
Entity
Organization
Contact information
Practice address
1540 REPUBLIC CIR, MIDWEST CITY, OK 73110-7971
(405) 732-8568
(405) 732-6615
Mailing address
PO BOX 30033, MIDWEST CITY, OK 73140-3033
(405) 732-8568
(405) 732-6615
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
OK
Other
Enumeration date
09/22/2006
Last updated
08/22/2020
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