Provider Demographics
NPI:1427423565
Name:OCCIC
Entity type:Organization
Organization Name:OCCIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUDIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:TIVE
Authorized Official - Phone:1405-945-6230
Mailing Address - Street 1:2625 GENERAL PERSHING BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107
Mailing Address - Country:US
Mailing Address - Phone:405-887-3190
Mailing Address - Fax:
Practice Address - Street 1:2625 GENERAL PERSHING BOULEVARD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107
Practice Address - Country:US
Practice Address - Phone:405-887-3190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKY000013649320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness