1679806392 NPI number — MCCALL'S CHAPEL SCHOOL INC

Table of content: (NPI 1679806392)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679806392 NPI number — MCCALL'S CHAPEL SCHOOL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCALL'S CHAPEL SCHOOL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MCCALL'S CHAPEL SCHOOL INC - COTTAGE 15
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679806392
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13546 COUNTY ROAD 3600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74820-5378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-272-6600
Provider Business Mailing Address Fax Number:
580-272-6665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13546 COUNTY ROAD 3600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74820-5378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-272-6600
Provider Business Practice Location Address Fax Number:
580-272-6665
Provider Enumeration Date:
09/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HONEYMAN
Authorized Official First Name:
NINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
580-272-6615

Provider Taxonomy Codes

  • Taxonomy code: 310500000X , with the licence number:  NH6220-6220 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100773130Y , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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