1275777690 NPI number — OAKWOOD HEALTHCARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275777690 NPI number — OAKWOOD HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKWOOD HEALTHCARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BEAUMONT HOSPITAL, TAYLOR
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275777690
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26901 BEAUMONT BLVD
Provider Second Line Business Mailing Address:
COMPLIANCE
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48033-4716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
947-522-1964
Provider Business Mailing Address Fax Number:
313-791-4663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10000 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48180-3330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-295-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ODOM
Authorized Official First Name:
LEE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PRESIDENT SHARED SERVICES
Authorized Official Telephone Number:
947-522-3326

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  820250 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 310555575 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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