Oklahoma Homes for the Developmentally Disabled, LLC

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

OKLAHOMA HOMES FOR THE DEVELOPMENTALLY DISABLED, LLC

Doing business as

Barry's Bunkhouse

Practice address

4621 Spring Ridge Rd
Enid, OK 73703-6006

Phone

(580) 234-8200

Fax

(580) 234-5078

NPI assigned

Oct 22, 2021

Organization subpart

Yes

Parent organization

OKLAHOMA HOMES FOR THE DEVELOPMENTALLY DISABLED, LLCAs reported in NPPES

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

Authorized official

Name

Consuela Dolezal

Title

Administrator

Phone

(580) 725-3533

Specialties & licenses 1

Addresses

Other names 1

• Barry's Bunkhouse Doing business as

Tax ID family

Oklahoma Homes for the Developmentally Disabled LLC4 organizations share this tax ID, including this one

Part of

Oklahoma Homes for the Developmentally Disabled LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Oklahoma Homes for the Developmentally Disabled, LLC

  dba Mattox Hall

  • Intellectual Disabilities Intermediate Care Facility
  • Garber, OK
  • NPI 1588179600
  NPD tax ID
• Oklahoma Homes for the Developmentally Disabled, LLC

  dba Britni's Bungalow

  • Intellectual Disabilities Intermediate Care Facility
  • Enid, OK
  • NPI 1720744808
  NPD tax ID
• Oklahoma Homes for the Developmentally Disabled, LLC

  • Developmental Disabilities Clinic/Center
  • Enid, OK
  • NPI 1851234843
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Oklahoma Homes for the Developmentally Disabled, LLC

  dba Mattox Hall

  • Intellectual Disabilities Intermediate Care Facility
  • Garber, OK
  • NPI 1588179600
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jami Luann Benton, M.D.

  • Family Medicine Physician
  • Enid, OK
  • NPI 1639224264
  NPD (past)

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

{
    "created_epoch": "1634860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634860800000",
    "number": "1558025916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4621 SPRING RIDGE RD",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737036006",
            "telephone_number": "580-234-8200",
            "fax_number": "580-234-5078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4621 SPRING RIDGE RD",
            "city": "ENID",
            "state": "OK",
            "postal_code": "737036006",
            "telephone_number": "580-234-8200",
            "fax_number": "580-234-5078"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "209 E Garber Rd",
            "address_purpose": "LOCATION",
            "city": "Garber",
            "state": "OK",
            "postal_code": "737381039",
            "country_code": "US",
            "telephone_number": "580-863-2200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OKLAHOMA HOMES FOR THE DEVELOPMENTALLY DISABLED, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OKLAHOMA HOMES FOR THE DEVELOPMENTALLY DISABLED, LLC",
        "enumeration_date": "2021-10-22",
        "last_updated": "2021-10-22",
        "certification_date": "2021-10-22",
        "status": "A",
        "authorized_official_last_name": "DOLEZAL",
        "authorized_official_first_name": "CONSUELA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "580-725-3533"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Barry's Bunkhouse",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual Disabilities Intermediate Care Facility in Enid, OK
• Providers in Enid, OK by specialty
• Intellectual Disabilities Intermediate Care Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.