| NPI | 1679565709 |
|---|---|
| Doing Business As | PROVIDENCE HOUSE |
| Entity Type | Organization |
| Authorized Contact | GREG MACHTOLFF Manager 405-282-2600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities (Licence: OK NH4208) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2011-09-08 |