Provider Demographics
NPI:1164648085
Name:OAKLAND HEIGHTS
Entity Type:Organization
Organization Name:OAKLAND HEIGHTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLEAK
Authorized Official - Suffix:
Authorized Official - Credentials:CNHA
Authorized Official - Phone:712-482-3566
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:IA
Mailing Address - Zip Code:51560-0459
Mailing Address - Country:US
Mailing Address - Phone:712-482-3566
Mailing Address - Fax:712-482-3609
Practice Address - Street 1:904 N SCENIC DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:IA
Practice Address - Zip Code:51560-4070
Practice Address - Country:US
Practice Address - Phone:712-482-3566
Practice Address - Fax:712-482-3609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0070310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0745919Medicaid