Basic Information
| Provider Information | |||||||||
| NPI: | 1780894121 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WESTERN PLAINS YOUTH & FAMILY SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1213 W HANKS TRAIL | ||||||||
| Address2: | |||||||||
| City: | WOODWARD | ||||||||
| State: | OK | ||||||||
| PostalCode: | 738017601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802563157 | ||||||||
| FaxNumber: | 5802561063 | ||||||||
| Practice Location | |||||||||
| Address1: | 505 S 3RD | ||||||||
| Address2: | |||||||||
| City: | MCALESTER | ||||||||
| State: | OK | ||||||||
| PostalCode: | 745015819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184290845 | ||||||||
| FaxNumber: | 9184290588 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 09/29/2010 | ||||||||
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| AuthorizedOfficialLastName: | EVANS | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5802545322 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | K860076 | OK | N | Agencies | Community/Behavioral Health | 253J00000X | K860000076 | OK | Y | Agencies | Foster Care Agency |
ID Information
| ID | Type | State | Issuer | Description | 100732920A | 05 | OK | MEDICAID |