NARCONON OF OKLAHOMA, INC (NPI# 1730339771) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730339771 |
| Entity Type | Organization |
| Organization Name | NARCONON OF OKLAHOMA, INC |
| Other Organization Name | NARCONON ARROWHEAD |
| Practice Address |
Hc 67 Box 5 Canadian OK 74425-9700 |
| Practice Telephone | 9545877771 |
| Practice Fax Number | 9545878622 |
| Mailing Telephone | 9545877771 |
| Mailing Fax Number | 9545878622 |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2008-09-26 |
| Authorized Official Name | DR. GERALD D WOOTAN (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 9545877771 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| Narconon Arrowhead | Doing Business As Name - Organization |
| Street Address |
HC 67 BOX 5 |
| City | CANADIAN |
| State | OK |
| Zip Code | 74425-9700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 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 |
| 1932404092 | Adam Russell | Community Health Worker | Hc 67 Box 5, Canadian, OK 74425-9700 | 2011-01-21 |
| 1174828156 | Terrence Thompson | Community Health Worker | Hc 67 Box 5, Canadian, OK 74425-9700 | 2011-01-21 |
| 1619272671 | Megan Badolato | Community Health Worker | Hc 67 Box 5, Canadian, OK 74425-9700 | 2011-01-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710015904 | Canadian Public School | Public Health or Welfare | 1 Belt Ave, Canadian, OK 74425 | 2007-03-01 |
| 1992163547 | Michael Edward Shuman Sr. | Community Health Worker | 69 Arrowhead Loop, Canadian, OK 74425 | 2016-02-10 |
| 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 |
| 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 |
| 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 |
| 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 |
| 1023420098 | Justin Dwayne Ross | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-05-27 |
| 1194137463 | Kimberly Irene Cooper | Substance Abuse Rehabilitation Facility | 69 Arrowhead Loop, Canadian, OK 74425-5012 | 2014-05-21 |
| Find all providers in CANADIAN | ||||
Please comment or provide details below to improve the information on NARCONON OF OKLAHOMA, INC.
| 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.