Provider Demographics
NPI:1144687922
Name:STILLWATER GROUP HOMES, INC.
Entity type:Organization
Organization Name:STILLWATER GROUP HOMES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-743-2496
Mailing Address - Street 1:904 W 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-5423
Mailing Address - Country:US
Mailing Address - Phone:405-743-2496
Mailing Address - Fax:405-743-2497
Practice Address - Street 1:904 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5423
Practice Address - Country:US
Practice Address - Phone:405-743-2496
Practice Address - Fax:405-743-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services