Provider Demographics
NPI:1497495782
Name:OAK STREET HEALTH
Entity Type:Organization
Organization Name:OAK STREET HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:336-200-7020
Mailing Address - Street 1:2668 PETERS CREEK PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127
Mailing Address - Country:US
Mailing Address - Phone:336-200-7020
Mailing Address - Fax:336-450-1843
Practice Address - Street 1:2668 PETERS CREEK PARKWAY
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127
Practice Address - Country:US
Practice Address - Phone:336-200-7020
Practice Address - Fax:336-450-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty