JUSTIN DWAYNE ROSS (NPI# 1023420098) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023420098 |
| Entity Type | Individual |
| Full Name | JUSTIN DWAYNE ROSS |
| Practice Address |
69 Arrowhead Loop Canadian OK 74425-5012 |
| Practice Telephone | 9183395800 |
| Practice Fax Number | 9183395801 |
| Mailing Telephone | 9183395800 |
| Mailing Fax Number | 9183395801 |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2014-05-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710473681 | Justin Taylor Ross | Dentist | 8938 S Broadway Ave Ste 380, Tyler, TX 75703 | 2018-07-03 |
| 1164608311 | Justin Scott Ross | Counselor | 340 17th St, Suite # 2, Ashland, KY 41101-7628 | 2008-01-18 |
| 1710536164 | Justin Gregory Ross | Counselor | 1211 W Vista Way Bldg C, Vista, CA 92083-6227 | 2019-09-09 |
| 1245690650 | Justin Ross | Student in an Organized Health Care Education/Training Program | 4190 City Ave, Philadelphia, PA 19131-1626 | 2016-02-26 |
| 1053785725 | Justin Ross | Counselor | 4144 E Amity Ave, Nampa, ID 83687-8802 | 2015-11-18 |
| 1861889081 | Justin Meir Ross | Emergency Medicine | 1650 Cochrane Cir Dept Of, Ft Carson, CO 80913 | 2015-04-26 |
| 1568854859 | Justin Ross | Pharmacist | 1690 Se Harvest Dr, Pullman, WA 99163-6000 | 2015-02-24 |
| 1023437761 | Justin Ross | Student in an Organized Health Care Education/Training Program | 275 W Macarthur Blvd, Kaiser Oakland Medical Center, Oakland, CA 94611-5641 | 2014-04-09 |
| 1124254495 | Justin Lee Ross | Chiropractor | 10110 Dixie Hwy, Louisville, KY 40272-3948 | 2009-06-01 |
| 1336390913 | Justin Daniel Ross | Psychologist | 789 N Sherman St, Suite 580, Denver, CO 80203-3529 | 2008-10-01 |
| Street Address |
69 ARROWHEAD LOOP |
| City | CANADIAN |
| State | OK |
| Zip Code | 74425-5012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366724924 | Lee Rain Wallin | Community Health Worker | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2011-09-09 |
| 1205317278 | Jennifer Ruth Howell | Case Manager/Care Coordinator | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2018-08-27 |
| 1821524109 | Mandy Jerome | Counselor | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2017-05-05 |
| 1457887739 | Crystal Lamb | Counselor | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2017-05-05 |
| 1992163547 | Michael Edward Shuman Sr. | Community Health Worker | 69 Arrowhead Loop, Canadian, OK 74425 | 2016-02-10 |
| 1518324250 | Charles Alan Flucard | Community Health Worker | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2016-01-26 |
| 1417356015 | Heather Miller | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-08-19 |
| 1699174284 | Derry Hallmark | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-08-19 |
| 1962811802 | Dylan Victor Leslie | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-08-05 |
| 1790199263 | Ryan Donald Pointek | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-06-12 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710015904 | Canadian Public School | Public Health or Welfare | 1 Belt Ave, Canadian, OK 74425 | 2007-03-01 |
| 1306262159 | Morgan Pinson | Counselor | 51 Gaines Creek Rd, Canadian, OK 74425-5176 | 2014-03-17 |
| 1730339771 | Narconon of Oklahoma, Inc | Substance Abuse Rehabilitation Facility | Hc 67 Box 5, Canadian, OK 74425-9700 | 2008-09-26 |
| 1508154618 | Karen Shuman | Case Manager/Care Coordinator | Hc 67 Box 5, Canadian, OK 74425-9700 | 2011-07-11 |
| 1467759134 | Anthony Lee Landers | Community Health Worker | Hc 67 Box 5, Canadian, OK 74425-9700 | 2011-02-16 |
| 1326343260 | Rebecca Fontenot | Community Health Worker | Hc 67 Box 5, Canadian, OK 74425-9700 | 2011-01-25 |
| 1912202870 | Alex Prince | Community Health Worker | Hc 67 Box 5, Canadian, OK 74425-9700 | 2011-01-24 |
| 1114222015 | Marcus Fontenot | Community Health Worker | Hc 67 Box 5, Canadian, OK 74425-9700 | 2011-01-24 |
| 1285939298 | Michael Magee | Community Health Worker | Hc 67 Box 5, Canadian, OK 74425-9700 | 2011-01-22 |
| 1336444306 | Ronald Patenaude | Community Health Worker | Hc 67 Box 5, Canadian, OK 74425-9700 | 2011-01-21 |
| Find all providers in zip 74425 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093127979 | Kimberly Ann Kelly-lorenz | Substance Abuse Rehabilitation Facility | 163 Mohawk Dr, Canadian, OK 74425-9747 | 2014-05-27 |
| 1730339771 | Narconon of Oklahoma, Inc | Substance Abuse Rehabilitation Facility | Hc 67 Box 5, Canadian, OK 74425-9700 | 2008-09-26 |
| 1417356015 | Heather Miller | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-08-19 |
| 1699174284 | Derry Hallmark | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-08-19 |
| 1962811802 | Dylan Victor Leslie | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-08-05 |
| 1790199263 | Ryan Donald Pointek | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-06-12 |
| 1386056109 | Nellabeth Alexander-richmond | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-05-28 |
| 1932511789 | William Patrick Lott | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-05-28 |
| 1770995516 | Liberty Maria Burkhart | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-05-28 |
| 1194137463 | Kimberly Irene Cooper | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-05-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.