NPIMap

Organization Active NPI

State of Oklahoma

  • Substance Abuse Rehabilitation Facility
  • Woodward, OK
National Provider Identifier
1700950201
Registry record updated Mar 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
STATE OF OKLAHOMA
Practice address
5050 Williams Avenue
Northwest Center for Behavioral Health
Woodward, OK 73801
Phone
(580) 256-9700
Fax
(580) 256-9704
NPI assigned
Nov 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2022

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

Authorized official

Name
Autumn Nickelson, LADC/LCSW
Title
Executive Director
Phone
(580) 571-3231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X Primary

Addresses

Primary practice location

5050 Williams Avenue
Northwest Center for Behavioral Health
Woodward, OK 73801

Mailing address

1222 10TH Street, Suite 211
Northwest Center for Behavioral Health
Woodward, OK 73801-3156
Phone (580) 571-3217

National Provider Directory

National Provider Directory
Tax ID family
Sallisaw State Veterans Home140 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

604 Choctaw St
Alva, OK 73717
Phone (580) 327-1112

1425 N Main St
Fairview, OK 73737
Phone (580) 227-2088

5050 Williams Ave
Woodward, OK 73801
Phone (580) 256-9700

Practitioners & affiliated clinicians

Practitioners 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648080000000",
    "number": "1700950201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 10TH STREET, SUITE 211",
            "address_2": "NORTHWEST CENTER FOR BEHAVIORAL HEALTH",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "738013156",
            "telephone_number": "580-571-3217",
            "fax_number": "580-256-8609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 WILLIAMS AVENUE",
            "address_2": "NORTHWEST CENTER FOR BEHAVIORAL HEALTH",
            "city": "WOODWARD",
            "state": "OK",
            "postal_code": "73801",
            "telephone_number": "580-256-9700",
            "fax_number": "580-256-9704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF OKLAHOMA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A",
        "authorized_official_last_name": "NICKELSON",
        "authorized_official_first_name": "AUTUMN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "580-571-3231",
        "authorized_official_credential": "LADC/LCSW"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodward, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2022; 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.