| Full Life Family Resource Center Llc | |
|
205 Main St Broken Bow OK 74728-3975 | |
| (580) 584-2478 | |
| (580) 584-2478 |
| Full Name | Full Life Family Resource Center Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 205 Main St, Broken Bow, Oklahoma |
| Authorized Official Name and Position | Glynis Daniel (PRESIDENT) |
| Authorized Official Contact | 5805842478 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Full Life Family Resource Center Llc 205 Main St Broken Bow OK 74728-3975 Ph: (580) 584-2478 | Full Life Family Resource Center Llc 205 Main St Broken Bow OK 74728-3975 Ph: (580) 584-2478 |
| NPI Number | 1215353016 |
|---|---|
| Provider Enumeration Date | 03/17/2014 |
| Last Update Date | 03/17/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215353016 | NPI | - | NPPES |
| 447-76-2689 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 3881 (Oklahoma) | Primary |
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