Providence Service Corp

LBN: Providence Service Corp
Providence Service Corp is an health care organization with primary practice located at 117 E Main St , Hugo OK 74743-6237. The organization recently has only one registered license in Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), which is considered as the primary health care specialty. Providence Service Corp can be contacted via phone (580) 326-7477, or through Myers, Tara A via phone (580) 326-7477.

Contact Information

Primary practice address
117 E Main St Hugo OK 74743-6237
Phone: (580) 326-7477
Fax: (580) 326-6400
Website:
Map and Directions
Authorized official contact:
Name: Myers, Tara A BA, PSRS
Phone: (580) 326-7477

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) 261QM0801X

Profile Details

NPI number 1164721056
LBN Legal business name Providence Service Corp
DBA Doing business as
Authorized official Myers, Tara A BA, PSRS
Entity Organization
Organization subpart 1 No
Enumeration date Mar 18th, 2011
Last updated Mar 18th, 2011 - about 15 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164721056 NPPES
Oklahoma MEDICAID 100750190

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