Provider Demographics
NPI:1144511221
Name:URBAN ADVANTAGE
Entity type:Organization
Organization Name:URBAN ADVANTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:BA, BHRS
Authorized Official - Phone:405-837-1065
Mailing Address - Street 1:12205 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-7801
Mailing Address - Country:US
Mailing Address - Phone:405-837-1065
Mailing Address - Fax:
Practice Address - Street 1:12205 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-7801
Practice Address - Country:US
Practice Address - Phone:405-837-1065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherINDEPENDENT CONTRACTOR