1902040330 NPI number — OAKWOOD HEALTHCARE INC

Table of content: (NPI 1902040330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902040330 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:
OAKWOOD ANNAPOLIS HOSPITAL
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:
1902040330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2023
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:
947-522-1963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33155 ANNAPOLIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48184-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-467-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SUSICK
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
947-522-3338

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  820010 , 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: 301558236 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com