Organization
LOOSEN CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JIM OBRIEN SR. (EXECUTIVE DIRECTOR)
(405) 263-4658
Entity
Organization
Contact information
Practice address
6TH AND TEXAS, OKARCHE, OK 73762-0245
(405) 263-4658
(405) 263-4718
Mailing address
PO BOX 245, OKARCHE, OK 73762-0245
(405) 263-4658
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
315P00000X
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100771890A
—
OK
Enumeration date
06/03/2008
Last updated
06/03/2008
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