1740230648 NPI number — OAKWOOD HEALTHCARE, INC.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740230648 NPI number — OAKWOOD HEALTHCARE, INC.

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 Other Organization Name:

BEAUMONT HOSPITAL - TRENTON

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:

1740230648

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

05/11/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

26901 BEAUMONT BLVD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SOUTHFIELD

Provider Business Mailing Address State Name:

MI

Provider Business Mailing Address Postal Code:

48033-3849

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

947-522-1963

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

5450 FORT ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

TRENTON

Provider Business Practice Location Address State Name:

MI

Provider Business Practice Location Address Postal Code:

48183-4601

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

734-671-3800

Provider Business Practice Location Address Fax Number:

734-671-3891

Provider Enumeration Date:

05/11/2006

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

• Taxonomy code: 282N00000X , with the licence number:  820170 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 49330 . This is a "OMNICARE COVENTRY PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 6331160 . This is a "AETNA PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: HL820021 . This is a "M-CARE PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 301557364 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: P00019 . This is a "BCN PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 405171889 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 230176 . This is a "OSCAR" identifier . This identifiers is of the category "OTHER".
• Identifier: 101730 . This is a "CHS/WELLNESS PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 104666 . This is a "CARE CHOICE PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 000000001514 . This is a "CAPE HEALTH PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 00079 . This is a "BCBS PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
• Identifier: 007589 . This is a "MIDWEST HLTH PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".