Provider Demographics
NPI:1023133063
Name:SERTOMA HANDICAPPED OPPORTUNITY PROGRAM
Entity type:Organization
Organization Name:SERTOMA HANDICAPPED OPPORTUNITY PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF VOCATIONAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:DERICK
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-835-7467
Mailing Address - Street 1:222 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-2202
Mailing Address - Country:US
Mailing Address - Phone:918-835-7467
Mailing Address - Fax:918-835-3274
Practice Address - Street 1:222 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-2202
Practice Address - Country:US
Practice Address - Phone:918-835-7467
Practice Address - Fax:918-835-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services