Provider Demographics
NPI:1730203951
Name:RED ROCK BEHAVORIAL HEALTH SERVICES
Entity type:Organization
Organization Name:RED ROCK BEHAVORIAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:QUINTILA
Authorized Official - Last Name:RIDEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:405-425-0333
Mailing Address - Street 1:3915 NW 122ND ST
Mailing Address - Street 2:APT C
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8209
Mailing Address - Country:US
Mailing Address - Phone:405-514-4393
Mailing Address - Fax:405-425-0312
Practice Address - Street 1:4404 N. LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105
Practice Address - Country:US
Practice Address - Phone:405-425-0333
Practice Address - Fax:405-425-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children