Organization Name: | 3C OLD FASHION BOARDING HOME |
NPI Number: | 1124359047 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JVON COOK (OWNER) |
Mailing Address: | 719 S Jim Thorpe Blvd Nbu 1706 Prague |
State: | OK US |
Postal Code: | 748643505 |
Phone Number: | 4055672280 |
Fax Number: | 4055672280 |
NPI Enumeration Date: | 01/15/2010 |
NPI Last Update Date: | 01/15/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3104A0625X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | Assisted Living, Mental Illness |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |