Provider Demographics
NPI:1730410267
Name:ROCMND AREA YOUTH SERVICES INC.
Entity type:Organization
Organization Name:ROCMND AREA YOUTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. DIR.
Authorized Official - Prefix:MISS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-256-7515
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:212 SE. 1ST
Mailing Address - City:PRYOR
Mailing Address - State:OK
Mailing Address - Zip Code:74362-0912
Mailing Address - Country:US
Mailing Address - Phone:918-825-4115
Mailing Address - Fax:918-825-6612
Practice Address - Street 1:212 SE. 1ST
Practice Address - Street 2:
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74362-0912
Practice Address - Country:US
Practice Address - Phone:918-825-4115
Practice Address - Fax:918-825-6612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3702251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732380FMedicaid