Provider Demographics
NPI:1558862433
Name:OAKWOOD ACCOUNTABLE CARE ORGANIZATION, LLC
Entity Type:Organization
Organization Name:OAKWOOD ACCOUNTABLE CARE ORGANIZATION, LLC
Other - Org Name:BEAUMONT ACO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR & COO
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:R
Authorized Official - Last Name:LORANG
Authorized Official - Suffix:III
Authorized Official - Credentials:MBA
Authorized Official - Phone:947-522-0031
Mailing Address - Street 1:26901 BEAUMONT BLVD.
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033
Mailing Address - Country:US
Mailing Address - Phone:947-522-0031
Mailing Address - Fax:
Practice Address - Street 1:26901 BEAUMONT BLVD.
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033
Practice Address - Country:US
Practice Address - Phone:947-522-0031
Practice Address - Fax:947-522-0038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization