Provider Demographics
NPI:1215150537
Name:DUNCAN COMMUNITY RESIDENCE, INC
Entity type:Organization
Organization Name:DUNCAN COMMUNITY RESIDENCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-255-3926
Mailing Address - Street 1:PO BOX 1474
Mailing Address - Street 2:1510 W. MAIN
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73534-1474
Mailing Address - Country:US
Mailing Address - Phone:580-255-3926
Mailing Address - Fax:580-255-8877
Practice Address - Street 1:1510 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-4333
Practice Address - Country:US
Practice Address - Phone:580-255-3926
Practice Address - Fax:580-255-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKRC6901-69013104A0625X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness