Provider Demographics
NPI:1427865930
Name:LIFT COMMUNITY ACTION AGENCY, INC
Entity type:Organization
Organization Name:LIFT COMMUNITY ACTION AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-326-3351
Mailing Address - Street 1:209 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-3809
Mailing Address - Country:US
Mailing Address - Phone:580-326-3351
Mailing Address - Fax:
Practice Address - Street 1:1005 S 5TH ST BLDG 4
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-8013
Practice Address - Country:US
Practice Address - Phone:803-263-3515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder