ECKERD YOUTH ALTERNATIVES, INC., DBA ECKERD CONNECTS


Address: 5350 S Western Ave, Suite 600, Oklahoma City, OK 73109-4520
Phone: 4056365956

ECKERD YOUTH ALTERNATIVES, INC., DBA ECKERD CONNECTS (NPI# 1104263797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1104263797
Entity Type Organization
Organization Name ECKERD YOUTH ALTERNATIVES, INC., DBA ECKERD CONNECTS
Practice Address 5350 S Western Ave
Suite 600
Oklahoma City
OK 73109-4520
Mailing Address 100 Starcrest Dr
Clearwater
FL 33765-3224
Practice Telephone 4056365956
Mailing Telephone 7274612990
Mailing Fax Number 7272160088
Enumeration Date 2013-05-23
Last Update Date 2019-09-10
Authorized Official Name DAVID DENNIS (CEO)
Authorized Official Telephone 7274612990
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 253J00000X Foster Care Agency Agencies
Y 320800000X Community Based Residential Treatment Facility, Mental Illness Residential Treatment Facilities

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1558664797 Eckerd Youth Alternatives, Inc., Dba Eckerd Connects Community/Behavioral Health 400 S Zang Blvd, Suite 220, Dallas, TX 75208-6600 2010-12-09

Office Location

Street Address 5350 S WESTERN AVE
SUITE 600
City OKLAHOMA CITY
State OK
Zip Code 73109-4520

Providers in the same location

NPI Name Taxonomy Address Enumeration
1316056534 Shadow Mountain Behavioral Health System, LLC Clinic/Center 5350 S Western Ave, Suite 555`, Oklahoma City, OK 73109-4520 2006-08-30
1225677644 Kyle William Ray Vail Case Management 5350 S Western Ave, Oklahoma City, OK 73109-4520 2020-01-02
1427692011 Lauren E Massad Counselor 5350 S Western Ave, Oklahoma City, OK 73109-4520 2019-11-06
1972073062 Courtney M Bolt Counselor 5350 S Western Ave, Oklahoma City, OK 73109-4520 2018-11-30
1821591983 Courtney Michele Folsom Counselor 5350 S Western Ave, Oklahoma City, OK 73109-4520 2018-03-15
1235672486 Chelsea Ricky Counselor 5350 S Western Ave, Oklahoma City, OK 73109 2016-11-21
1144776261 Heather Covarrubia Speech-Language Pathologist 5350 S Western Ave, Suite 131, Oklahoma City, OK 73109-4520 2016-08-29
1457701583 Amy Woodruff Speech-Language Pathologist 5350 S Western Ave, Suite 525, Oklahoma City, OK 73109-4520 2016-06-20
1053766634 Caitlin Taylor Ulrich Speech-Language Pathologist 5350 S Western Ave, #525, Oklahoma City, OK 73109-4520 2016-05-02
1538523865 Kristina Angelica Dominguez Speech-Language Pathologist 5350 S Western Ave, 525, Oklahoma City, OK 73109-4520 2016-04-12
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1063905354 Housecalls Family Medicine 4413 S Lee Ave, Oklahoma City, OK 73109 2018-06-11
1225559404 John Nathan Jacobsen Dentist 235 Sw 25th St., Oklahoma City, OK 73109 2017-06-28
1659828648 Cynthia Jane Laney Registered Nurse 4401 South Western, Oklahoma City, OK 73109 2016-09-07
1497104780 Hazel Soto Case Manager/Care Coordinator 420 Sw, St, Oklahoma, OK 73109 2016-06-07
1063873677 Ardeceley Brandi Annette Hernandez Community/Behavioral Health 5714 S. Western Ave, Oklahoma City, OK 73109 2016-03-09
1316343908 Van Ngo Nurse Practitioner 4413 South Lee Ave, Oklahoma City, OK 73109 2014-11-10
1104249150 Janessa Ladawn Bointy Counselor 5359 S. Western Ave. #707, Oklahoma City, OK 73109 2014-01-28
1033540299 Bryan Graham Case Manager/Care Coordinator 1111 Sw 28th St, Oklahoma City, OK 73109 2013-12-12
1154684603 Nubia Fiesel Counselor 420 Sw 10th Street, Oklahoma City, OK 73109 2012-06-20
1548533664 C.c. Freeman, Md. Inc Internal Medicine 4221 S. Western Ave., Suite 2015, Oklahoma City, OK 73109 2012-02-21
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Taxonomy Information

Taxonomy Code 320800000X
Grouping Residential Treatment Facilities
Classification Community Based Residential Treatment Facility, Mental Illness

Taxonomy Definition

A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness.
Notes: [7/1/2003: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1285966747 Dr. C Professional Services, Pllc Community Based Residential Treatment Facility, Mental Illness 7109 S Kentucky Ave, Oklahoma City, OK 73159-3427 2010-02-09
1427423565 Occic Community Based Residential Treatment Facility, Mental Illness 2625 General Pershing Boulevard, Oklahoma City, OK 73107 2015-12-01
1447673819 Red Rock Behavioral Health Services Community Based Residential Treatment Facility, Mental Illness 4130 N Lincoln Blvd, Oklahoma City, OK 73105-5209 2014-01-21
1053687780 Community Couseling Center, Inc. Community Based Residential Treatment Facility, Mental Illness 1700 Nw 17th St, Oklahoma City, OK 73106-4212 2012-03-27

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1801321070 April Brock Community Based Residential Treatment Facility, Mental Illness 106 12th Ave Ne, Miami, OK 74354-3373 2017-04-25
1114321486 Cedric Glenn Community Based Residential Treatment Facility, Mental Illness 1721 E 72nd St, 1803, Tulsa, OK 74136-5372 2014-10-15
1083058523 Mongo Allen Community Based Residential Treatment Facility, Mental Illness 829 Nw 142nd St, Edmond, OK 73013-1962 2013-04-27
1801133236 Southeastern Oklahoma Family Services Community Based Residential Treatment Facility, Mental Illness 1501 N Washington Ave, Durant, OK 74701-2127 2013-01-04
1043595879 Oaktree Counseling Services Community Based Residential Treatment Facility, Mental Illness 2104 Nw Britni Cir, Lawton, OK 73505-3121 2011-10-12
1790089829 Southern Oklahoma Treatment Services Community Based Residential Treatment Facility, Mental Illness 5862 Us Hwy 70, Mead, OK 73449 2011-01-04
1881921898 Sequoyah Residential Mental Health Facility, Inc Community Based Residential Treatment Facility, Mental Illness 103 N Wheeler Ave, Sallisaw, OK 74955-4617 2009-11-11
1790922185 State of Oklahoma Community Based Residential Treatment Facility, Mental Illness 2323 South Harvard, Tulsa, OK 74114 2009-01-07
1558570309 Meadow Brook Residential Care Facility Community Based Residential Treatment Facility, Mental Illness 1000 Meadow Lane, Howe, OK 74940 2007-05-21
1568580108 Transition House, Inc. Community Based Residential Treatment Facility, Mental Illness 700 Asp Ave, Suite 2, Norman, OK 73069-4900 2007-03-26
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Competitor

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City OKLAHOMA CITY
Zip Code 73109

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Dataset Information

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.

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