Provider Demographics
NPI:1699427005
Name:STEEPROCK, ADELBERT ISAIAH JEREL
Entity type:Individual
Prefix:
First Name:ADELBERT
Middle Name:ISAIAH JEREL
Last Name:STEEPROCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 STARTING POINT DR
Mailing Address - Street 2:
Mailing Address - City:PONCA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:74601-8308
Mailing Address - Country:US
Mailing Address - Phone:580-749-7322
Mailing Address - Fax:
Practice Address - Street 1:210 STARTING POINT DR
Practice Address - Street 2:
Practice Address - City:PONCA CITY
Practice Address - State:OK
Practice Address - Zip Code:74601-8308
Practice Address - Country:US
Practice Address - Phone:580-749-7322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility