Organization
OKLAHOMA PRODUCTION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EFFIE FOSTER (EXECUTIVE DIRECTOR)
(918) 456-1237
Entity
Organization
Contact information
Practice address
216 WEST AVE., TAHLEQUAH, OK 74464
(918) 456-1929
(918) 456-1969
Mailing address
PO BOX 774, TAHLEQUAH, OK 74465-0774
(918) 456-1929
(918) 456-1969
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100683000
—
OK
Enumeration date
08/09/2012
Last updated
08/09/2012
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