Provider Demographics
NPI:1215099510
Name:KI BOIS COMMUNITY ACTION FOUNDATION
Entity type:Organization
Organization Name:KI BOIS COMMUNITY ACTION FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:R.
Authorized Official - Middle Name:CARROLL
Authorized Official - Last Name:HUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-967-3325
Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-0727
Mailing Address - Country:US
Mailing Address - Phone:918-967-3325
Mailing Address - Fax:918-967-8660
Practice Address - Street 1:107 MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:OK
Practice Address - Zip Code:74432-3052
Practice Address - Country:US
Practice Address - Phone:918-689-3265
Practice Address - Fax:918-689-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK01-1372703251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100680370TMedicaid
OK100707530EMedicaid