Provider Demographics
NPI:1609014414
Name:THE OKUNAWOS CORPORATION
Entity Type:Organization
Organization Name:THE OKUNAWOS CORPORATION
Other - Org Name:PERMANENT GENERAL MERCHANDISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:OLA
Authorized Official - Last Name:OKUNAWO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-982-7381
Mailing Address - Street 1:6904 FAUST AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48228-3495
Mailing Address - Country:US
Mailing Address - Phone:313-982-7381
Mailing Address - Fax:
Practice Address - Street 1:6904 FAUST AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48228-3495
Practice Address - Country:US
Practice Address - Phone:313-982-7381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies