STATE OF OKLAHOMA DEPT. OF HUMAN SERVICES (NPI# 1295828895) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295828895 |
| Entity Type | Organization |
| Organization Name | STATE OF OKLAHOMA DEPT. OF HUMAN SERVICES |
| Other Organization Name | SOUTHER OKLAHOMA RESOURCE CENTER |
| Practice Address |
Rt. 1 Box 44-a Pauls Valley OK 73075 |
| Practice Telephone | 4052386401 |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. WILLIAM E JOHNSON (PROGRAMS MANAGER) |
| Authorized Official Telephone | 4055213565 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Souther Oklahoma Resource Center | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174610075 | State of Oklahoma Dept. of Human Services | Case Management | 2400 N Lincoln Blvd, Oklahoma City, OK 73125 | 2006-10-10 |
| 1609963800 | State of Oklahoma Dept. of Human Services | Pharmacy | Rt 1 Box 44a, Pauls Valley, OK 73075 | 2006-10-07 |
| 1669566576 | State of Oklahoma Dept. of Human Services | Community/Behavioral Health | 2400n Lincoln Blvd, Oklahoma City, OK 73125 | 2006-10-03 |
| Street Address |
RT. 1 BOX 44-A |
| City | PAULS VALLEY |
| State | OK |
| Zip Code | 73075 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194292490 | Jennifer Lynn Reicosky | Counselor | 513 Willow, Pauls Valley, OK 73075 | 2018-10-25 |
| 1336467299 | Fred Lee Mcginn Iv | Counselor | Atlc, 111 Arrowhead Dr., Pauls Valley, OK 73075 | 2010-05-17 |
| 1447435433 | Amanda Marie Hammonds | Physical Therapist | 37915 Ecr 1530, Pauls Valley, OK 73075 | 2008-01-08 |
| 1255533873 | Ladonna L.l. Lynnell Luckey | Counselor | 111 Arrowhead Drive, Adolescent Transitional Living Center, Pauls Valley, OK 73075 | 2007-06-05 |
| 1144369026 | James Ray Ward | Dentist | 112 N Oak, Pauls Valley, OK 73075 | 2007-02-06 |
| 1700953247 | Stanley Family Chiropractic PC | Chiropractor | 1555 W Grant, Pauls Valley, OK 73075 | 2006-11-29 |
| 1659458412 | Woodlawn, LLC | Respite Care | 1413 S. Chickasha, Pauls Valley, OK 73075 | 2006-11-01 |
| 1689750457 | Dana J Martin Dds PC | Dentist | 1600 Airline Road, Pauls Valley, OK 73075 | 2006-10-27 |
| 1609963800 | State of Oklahoma Dept. of Human Services | Pharmacy | Rt 1 Box 44a, Pauls Valley, OK 73075 | 2006-10-07 |
| 1760412258 | Travis Kent Scoggin | Dentist | 318 Melville Dr, Pauls Valley, OK 73075 | 2006-07-03 |
| Find all providers in zip 73075 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467959866 | Santa Fe Place LLC | Intermediate Care Facility, Mentally Retarded | 1000 S Santa Fe, Building C, Moore, OK 73160-2469 | 2018-04-11 |
| 1588179600 | Oklahoma Homes for The Developmentally Disabled, LLC | Intermediate Care Facility, Mentally Retarded | 209 E Garber Rd, Garber, OK 73738-1039 | 2017-12-12 |
| 1881055267 | Saint Andre' Bessette | Intermediate Care Facility, Mentally Retarded | 655 West Texas, Okarche, OK 73762-0245 | 2016-03-14 |
| 1598134165 | Guthrie Cottages, LLC | Intermediate Care Facility, Mentally Retarded | 2102 W Warner, Guthrie, OK 73044 | 2015-09-24 |
| 1407225071 | Westview Cottages, Inc | Intermediate Care Facility, Mentally Retarded | 1900 W Harrison Ave, Guthrie, OK 73044-4053 | 2015-09-24 |
| 1407240237 | Fairchild Home and Community Based Services, LLC | Intermediate Care Facility, Mentally Retarded | 205 E Maple, Billings, OK 74630 | 2015-03-18 |
| 1922230341 | Wvl I Lp | Intermediate Care Facility, Mentally Retarded | 2102 West Warner, Guthrie, OK 73044 | 2009-08-18 |
| 1265669667 | Gatesway Foundation Inc | Intermediate Care Facility, Mentally Retarded | 1305 E College St, Broken Arrow, OK 74012-4204 | 2009-06-12 |
| 1457501892 | Gatesway Foundation Inc | Intermediate Care Facility, Mentally Retarded | 1313 E. College, Broken Arrow, OK 74012 | 2008-09-23 |
| 1972762235 | Loosen Center | Intermediate Care Facility, Mentally Retarded | 6th and Texas, Okarche, OK 73762-0245 | 2008-06-03 |
| Find all providers with the same taxonomy | ||||
| City | PAULS VALLEY |
| Zip Code | 73075 |
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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.