Provider Demographics
NPI:1285047126
Name:DAYSPRING COMMUNITY SERVICES
Entity type:Organization
Organization Name:DAYSPRING COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATEWIDE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-712-0859
Mailing Address - Street 1:4010 N LINCOLN BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73105-5220
Mailing Address - Country:US
Mailing Address - Phone:918-712-0859
Mailing Address - Fax:918-388-6456
Practice Address - Street 1:4010 N LINCOLN BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-5220
Practice Address - Country:US
Practice Address - Phone:918-712-0859
Practice Address - Fax:918-388-6456
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTERNATIVE OPPORTUNITIES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100746170Medicaid