Organization Name: | GRAND LAKE MENTAL HEALTH CENTER, INC. |
NPI Number: | 1063817021 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHARLES DANLEY (CEO) |
Mailing Address: | 231 E Graham Ave Pryor |
State: | OK US |
Postal Code: | 743612436 |
Phone Number: | 9182731841 |
Fax Number: | |
NPI Enumeration Date: | 11/03/2014 |
NPI Last Update Date: | 11/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |