3C Old Fashion Boarding Home

Key facts

NPI

1124359047

Entity type

Organization (NPI type 2)

Primary specialty

Assisted Living Facility (Mental Illness) 3104A0625X

Legal business name

3C OLD FASHION BOARDING HOME

Practice address

719 S Jim Thorpe Blvd
Nbu 1706
Prague, OK 74864-3505

Phone

(405) 567-2280

Fax

(405) 567-2280

NPI assigned

Jan 15, 2010

Organization subpart

No

Authorized official

Name

Jvon Cook

Title

Owner

Phone

(405) 567-7677

National Provider Directory

Locations

Specialties & licenses

Addresses

Other names

• 3C Old Fashion Boarding Home Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 15, 2010.

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263513600000",
    "number": "1124359047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 S JIM THORPE BLVD",
            "address_2": "NBU 1706",
            "city": "PRAGUE",
            "state": "OK",
            "postal_code": "748643505",
            "telephone_number": "405-567-2280",
            "fax_number": "405-567-2280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 S JIM THORPE BLVD",
            "address_2": "NBU 1706",
            "city": "PRAGUE",
            "state": "OK",
            "postal_code": "748643505",
            "telephone_number": "405-567-2280",
            "fax_number": "405-567-2280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "3C OLD FASHION BOARDING HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-15",
        "last_updated": "2010-01-15",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "JVON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "405-567-7677"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "3C Old Fashion Boarding Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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