3c Old Fashion Boarding Home

NPI #1124359047 in Prague, Oklahoma

Provider Information

NPI Number: 1124359047
Entity Type: Organization
Organization Name: 3c Old Fashion Boarding Home
Primary Specialty: Assisted Living Facility - Assisted Living, Mental Illness
Enumeration Date: Jan 15, 2010
Last Updated: Jan 15, 2010

Practice Location

Address: 719 S JIM THORPE BLVD
Address 2: NBU 1706
City: Prague
State: Oklahoma
ZIP Code: 74864-3505
Phone: (405) 567-2280

Authorized Official

Name: JVON COOK
Title: OWNER
Phone: (405) 567-7677

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Assisted Living Facility - Assisted Living, Mental Illness — Assisted Living, Mental Illness	3104A0625X	Primary

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