Provider Demographics
NPI:1861704652
Name:KIAMCHI YOUTH SERVICES INC
Entity type:Organization
Organization Name:KIAMCHI YOUTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:RANAE
Authorized Official - Last Name:GRIFFIN-RAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:BS MED
Authorized Official - Phone:580-286-6671
Mailing Address - Street 1:1804 COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:IDABEL
Mailing Address - State:OK
Mailing Address - Zip Code:74745-7909
Mailing Address - Country:US
Mailing Address - Phone:580-286-6671
Mailing Address - Fax:580-286-5747
Practice Address - Street 1:116 SE AVE N
Practice Address - Street 2:
Practice Address - City:IDABEL
Practice Address - State:OK
Practice Address - Zip Code:74745-5234
Practice Address - Country:US
Practice Address - Phone:580-286-6671
Practice Address - Fax:580-286-5747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health