Grace Mukombe

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Practice address

3400 Deskin Dr # 8295
Norman, OK 73069-8295

Phone

(405) 701-8530

Fax

(405) 701-8529

NPI assigned

Sep 12, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1631404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631404800000",
    "number": "1992474969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 N EMERSON ST",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740373828",
            "telephone_number": "918-510-2958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 DESKIN DR # 8295",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730698295",
            "telephone_number": "405-701-8530",
            "fax_number": "405-701-8529"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4436 NW 50th St",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731122212",
            "country_code": "US",
            "telephone_number": "405-858-2700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUKOMBE",
        "first_name": "GRACE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-12",
        "last_updated": "2021-09-12",
        "certification_date": "2021-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gracem@redriverya.com",
            "affiliation": "Y",
            "affiliationName": "CBH of Norman Operating, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3400 Deskin Dr # 8295",
            "city": "Norman",
            "state": "OK",
            "country_code": "US",
            "postal_code": "730698295",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gracem@redriverya.com",
            "affiliation": "Y",
            "affiliationName": "CBH of Norman Operating, LLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3400 Deskin Dr # 8295",
            "city": "Norman",
            "state": "OK",
            "country_code": "US",
            "postal_code": "730698295",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Dylan Walker Mudd
• Layne Edward Mulkey
• Michael Anthony Mullane
• Maggie Mullenix
• Susan Ann Muller, R.N.
• Breanna Lynn Mulliner, BCBA

• Emotionally Disturbed Childrens' Residential Treatment Facility in Norman, OK
• Providers in Norman, OK by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.