JACK BROWN TREATMENT CENTER (NPI# 1780939223) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780939223 |
| Entity Type | Organization |
| Organization Name | JACK BROWN TREATMENT CENTER |
| Practice Address |
17091 S Muskogee Ave Tahlequah OK 74465 |
| Mailing Address |
Po Box 397 Park Hill OK 74451-0397 |
| Practice Telephone | 9184535501 |
| Practice Fax Number | 9184580499 |
| Enumeration Date | 2012-07-20 |
| Last Update Date | 2012-07-20 |
| Authorized Official Name | MR. DARREN DRY (DIRECTOR) |
| Authorized Official Telephone | 9184535519 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3245S0500X |
Substance Abuse Rehabilitation Facility Specialization: Substance Abuse Treatment, Children |
Residential Treatment Facilities |
| Street Address |
17091 S MUSKOGEE AVE |
| City | TAHLEQUAH |
| State | OK |
| Zip Code | 74465 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609123892 | Sonya Davidson | Counselor | 17091 S Muskogee Ave, Tahlequah, OK 74465-0000 | 2012-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437396850 | Jack Brown Center | Substance Abuse Rehabilitation Facility | 17091 South Muskogee Avenue, Tahlequah, OK 74465 | 2009-01-08 |
| 1821287962 | Cornerstone Home Health Care | Home Health | 1699 West Fourth Street, Tahlequah, OK 74465 | 2007-10-15 |
| 1144414764 | Adam Carroll Cothran | Social Worker | 17675 S. Muskogee Ave., Tahlequah, OK 74465 | 2007-08-28 |
| 1194895441 | Eeg Corporation | Psychiatry & Neurology | 1400 E Downing, Tahlequah, OK 74465 | 2006-11-08 |
| 1700951050 | Harold Earl Goldman | Pediatrics | 1400 E Downing, Tahlequah, OK 74465 | 2006-11-22 |
| 1508987959 | State of Oklahoma; Dba:bill Willis Community Mental Health Center | Clinic/Center | 1400 S. Hensley Dr, Tahlequah, OK 74465-0558 | 2007-04-03 |
| 1386914646 | Debra Lee Johnson | Case Manager/Care Coordinator | 17091 South Muskogee Avenue, Cherokee Nation, Tahlequah, OK 74465-0948 | 2012-01-04 |
| 1770937229 | Talking Leaves Job Corps | Psychologist | 5700 Bald Hill Road, Tahlequah, OK 74465-1066 | 2016-04-21 |
| 1689909574 | Lori Elizabeth Medina | Counselor | 17091 S. Muskogee, Tahlequah, OK 74465-4405 | 2009-10-09 |
| Taxonomy Code | 3245S0500X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| Specialization | Substance Abuse Treatment, Children |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801317821 | Substance Abuse Foundatiion for Educaiton | Substance Abuse Rehabilitation Facility | 1618 Se 59th St, Oklahoma City, OK 73129-7314 | 2017-06-29 |
| 1841681160 | April Esther Pahari | Substance Abuse Rehabilitation Facility | 2424 N Quebec Ave, Tulsa, OK 74115-3209 | 2015-02-09 |
| 1043630676 | Direct Care Counseling Services, LLC | Substance Abuse Rehabilitation Facility | 2200 Hardin Dr, Oklahoma City, OK 73111-1727 | 2014-04-22 |
| 1932403276 | Franks | Substance Abuse Rehabilitation Facility | 402 S.w. Mass. Ave, Langston, OK 73050-0495 | 2010-12-30 |
| 1235458571 | Tjs Daycare | Substance Abuse Rehabilitation Facility | 2808 Ne 23rd St, Oklahoma City, OK 73121-2453 | 2010-05-26 |
| 1154520856 | White Horse Ranch | Substance Abuse Rehabilitation Facility | 1601 Wilkie Rd, Mooreland, OK 73852-8921 | 2007-07-12 |
| 1801014550 | Monarch, Inc | Substance Abuse Rehabilitation Facility | 2310 W Broadway St, Muskogee, OK 74401-2761 | 2007-04-20 |
| 1851420384 | Tulsa Boys' Home | Substance Abuse Rehabilitation Facility | 2727 S 137th W Ave, Sand Springs, OK 74063-5017 | 2007-03-02 |
| 1184795338 | Four Winds Ranch Recovery Center for Adolescent Females L.L.C. | Substance Abuse Rehabilitation Facility | 501 N Santa Fe Rd, Guthrie, OK 73044-8982 | 2006-11-10 |
| 1255749917 | Monarch, Inc | Substance Abuse Rehabilitation Facility | 2310 W Broadway St, Muskogee, OK 74401-2761 | 2014-07-25 |
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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.