Country Road Operations LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

COUNTRY ROAD OPERATIONS LLC

Practice address

24962 Okay Rd
Tecumseh, OK 74873-6504

Phone

(405) 253-2020

NPI assigned

Dec 14, 2020

Last updated

Dec 14, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Daniel Mandelbaum

Title

Ceo

Phone

(718) 570-6018

Specialties & licenses 1

Addresses

Other names 1

• Avenues of Oklahoma Former legal business name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christopher James Snyder, D.O.

  • Psychiatry Physician
  • Tulsa, OK
  • NPI 1205270725
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607904000000",
    "number": "1073109112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24962 OKAY RD",
            "city": "TECUMSEH",
            "state": "OK",
            "postal_code": "748736504",
            "telephone_number": "405-253-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24962 OKAY RD",
            "city": "TECUMSEH",
            "state": "OK",
            "postal_code": "748736504",
            "telephone_number": "405-253-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY ROAD OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-14",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A",
        "authorized_official_last_name": "MANDELBAUM",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "718-570-6018"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avenues of Oklahoma",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Melissa Capps
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• Gerardo Cervantes
• Timothy Ray Chandler, LPN
• Jarred James Coffman
• Tristan Dirksen
• Lisa Ann Estell, PTA
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• Emake M Fisher
• Kendra Fixico, PTA

• Substance Abuse Rehabilitation Facility in Tecumseh, OK
• Providers in Tecumseh, OK by specialty
• Substance Abuse Rehabilitation Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.