Provider Demographics
NPI:1063757797
Name:ROGERS COUNTY YOUTH SERVICES, INC.
Entity type:Organization
Organization Name:ROGERS COUNTY YOUTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HERB
Authorized Official - Middle Name:V
Authorized Official - Last Name:MCSPADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-341-7580
Mailing Address - Street 1:2680 N HIGHWAY 88
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-0409
Mailing Address - Country:US
Mailing Address - Phone:918-341-7580
Mailing Address - Fax:918-341-7977
Practice Address - Street 1:2680 N HIGHWAY 88
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-0409
Practice Address - Country:US
Practice Address - Phone:918-341-7580
Practice Address - Fax:918-341-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health