| NPI | 1215150537 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN D WOLFF Administrator 580-255-3926 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: OK RC6901-6901) |
| Additional Taxonomies | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: OK RC6901-6901) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2009-11-16 |