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).
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 |
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 |
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 |
Street Address |
5350 S WESTERN AVE SUITE 600 |
City | OKLAHOMA CITY |
State | OK |
Zip Code | 73109-4520 |
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 |
Find all providers in the same location |
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 |
Find all providers in zip 73109 |
Taxonomy Code | 320800000X |
Grouping | Residential Treatment Facilities |
Classification | Community Based Residential Treatment Facility, Mental Illness |
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
Notes: [7/1/2003: new] |
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 |
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 |
Find all providers with the same taxonomy |
City | OKLAHOMA CITY |
Zip Code | 73109 |
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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.