MONGO ALLEN

EDMOND, OK
NPI1083058523
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy251S00000X 
Additional Taxonomies320800000X Community Based Residential Treatment Facility, Mental Illness
Enumeration Date2013-04-27
Last Update Date2013-04-27
Business Address
-- MONGO ALLEN M. ED
829 NW 142ND ST
EDMOND, OK 73013-1962
Phone number: 405-315-0855
Mailing Address
-- MONGO ALLEN M. ED
829 NW 142ND ST
EDMOND, OK 73013-1962
Phone number: 405-242-3423