Provider Demographics
NPI:1538903844
Name:GREAT PLAINS RECOVERY CENTER
Entity type:Organization
Organization Name:GREAT PLAINS RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAANAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DVIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-310-1490
Mailing Address - Street 1:1 ASH ST
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1620
Mailing Address - Country:US
Mailing Address - Phone:918-310-1490
Mailing Address - Fax:
Practice Address - Street 1:7210 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6319
Practice Address - Country:US
Practice Address - Phone:203-606-5984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-21
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility