Provider Demographics
NPI:1699980623
Name:NORTHCARE CENTER
Entity type:Organization
Organization Name:NORTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LYNELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-858-2733
Mailing Address - Street 1:809 HEATHERHILL CT
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-4219
Mailing Address - Country:US
Mailing Address - Phone:405-360-3942
Mailing Address - Fax:
Practice Address - Street 1:1140 N HUDSON AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-3918
Practice Address - Country:US
Practice Address - Phone:405-272-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2547251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health