COUNTRY ROAD OPERATIONS LLC NPI 1073109112

NPI Information

  • NPI: 1073109112
  • Provider Name: COUNTRY ROAD OPERATIONS LLC
  • Classification: Substance Abuse Rehabilitation Facility - 324500000X
  • Entity Type: Organization
  • CLIA Number: 37D2093226
  • Address: 24962 OKAY RD
    TECUMSEH, OK
    ZIP 74873
  • Phone: (405) 253-2020

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NPI Details

COUNTRY ROAD OPERATIONS LLC is a substance abuse rehabilitation facility in Tecumseh, OK. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. COUNTRY ROAD OPERATIONS LLC NPI is 1073109112. The provider is registered as an organization entity type.

The provider's business location address is:

24962 OKAY RD
TECUMSEH, OK
ZIP 74873-504
Phone: (405) 253-2020

The provider's authorized official is Daniel Mandelbaum .
The authorized official title is Ceo and has the following contact phone number (718) 570-6018.

The CLIA number assigned to this NPI record is 37D2093226 - ancillary testing site in health care center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/14/2020 and was last updated on 12/14/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1324500000XSubstance Abuse Rehabilitation FacilityYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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