Provider Demographics
NPI:1154652915
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. DIRECTOR
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 1:33 N MAIN ST STE 8
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-3359
Mailing Address - Country:US
Mailing Address - Phone:918-540-1563
Mailing Address - Fax:918-542-7778
Practice Address - Street 1:33 N MAIN ST STE 8
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-3359
Practice Address - Country:US
Practice Address - Phone:918-540-1563
Practice Address - Fax:918-542-7778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100732380CMedicaid