Provider Demographics
NPI:1003003617
Name:OAKLAND FAMILY SERVICES
Entity Type:Organization
Organization Name:OAKLAND FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JAIMIE
Authorized Official - Middle Name:PEARL
Authorized Official - Last Name:CLAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-858-7766
Mailing Address - Street 1:114 ORCHARD LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341
Mailing Address - Country:US
Mailing Address - Phone:248-858-7766
Mailing Address - Fax:248-858-7201
Practice Address - Street 1:2351 WEST 12 MILE ROAD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072
Practice Address - Country:US
Practice Address - Phone:248-544-4004
Practice Address - Fax:248-544-4013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKLAND FAMILY SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-27
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI630317251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1883825Medicaid
MIM03340Medicare UPIN
MIF37164Medicare UPIN
MI1883825Medicaid