Provider Demographics
NPI:1588915771
Name:CANA MISSIONS, LLC
Entity type:Organization
Organization Name:CANA MISSIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MACHTOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-414-3891
Mailing Address - Street 1:1409 S DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-5009
Mailing Address - Country:US
Mailing Address - Phone:405-293-9774
Mailing Address - Fax:
Practice Address - Street 1:1409 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-5009
Practice Address - Country:US
Practice Address - Phone:405-293-9774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3181251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health