1861666265 NPI number — OAKWOOD HEALTHCARE, INC

Table of content: (NPI 1861666265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861666265 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:
Provider Other Organization Name Type Code:
6
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:
1861666265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2021
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:
947-522-1963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18101 OAKWOOD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEARBORN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48124-4089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-586-5011
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/16/2008

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: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282N00000X , with the licence number: 820120 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 006403 . This is a "MIDWEST" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 6330275 . This is a "AETNA PROVIDER#" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 104641 . This is a "CARE CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 000000001513 . This is a "CAPE HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 49342 . This is a "OMNICARE CONVENTRY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: P00205 . This is a "BCN PROVIDER #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 101520 . This is a "CHS WELLNESS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 118626 . This is a "GREATLAKES HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 00205 . This is a "BCBS PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 40205 . This is a "BCBS SPRINGWELLS PROV #" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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