Provider Demographics
NPI:1801321070
Name:APRIL BROCK
Entity type:Organization
Organization Name:APRIL BROCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RSS
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-961-8585
Mailing Address - Street 1:106 12TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-3373
Mailing Address - Country:US
Mailing Address - Phone:918-961-8585
Mailing Address - Fax:
Practice Address - Street 1:106 12TH AVE NE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-3373
Practice Address - Country:US
Practice Address - Phone:918-961-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKH082815282320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness