1679580864 NPI number — OAKWOOD HOME CARE SERVICES

Table of content: (NPI 1679580864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679580864 NPI number — OAKWOOD HOME CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAKWOOD HOME CARE SERVICES
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 HOME CARE
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:
1679580864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1633 FAIRLANE CIRCLE SUITE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALLEN PARK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48101-3660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-757-7711
Provider Business Mailing Address Fax Number:
313-996-3102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1633 FAIRLANE CIR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ALLEN PARK
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48101-3660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-757-7711
Provider Business Practice Location Address Fax Number:
313-996-3102
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOUPIS
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
313-996-3023

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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: 237211 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 127837 . This is a "GREAT LAKES HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000003409 . This is a "CAPE HEALTH" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OE115 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2598361 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH820004 . This is a "M-CARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: OE115 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 111432 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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