Basic Information
| Provider Information | |||||||||
| NPI: | 1710013552 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALTERNATIVE OPPORTUNITIES INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DAYSPRING COMMUNITY SERVICES | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 N WALKER AVE | ||||||||
| Address2: | SUITE 190 & 200 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731021619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4057029721 | ||||||||
| FaxNumber: | 4057029720 | ||||||||
| Practice Location | |||||||||
| Address1: | 5525 E 51ST ST | ||||||||
| Address2: | SUITE #400 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741357461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187120859 | ||||||||
| FaxNumber: | 9183886456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 05/30/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PEDERSON-RAMBO | ||||||||
| AuthorizedOfficialFirstName: | MORNA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4057029721 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 100746170A | 05 | OK | MEDICAID |