Provider Demographics
NPI:1700053535
Name:ST JOHN OAKLAND HOSPITAL
Entity Type:Organization
Organization Name:ST JOHN OAKLAND HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:VIRGONA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-967-7434
Mailing Address - Street 1:27351 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-3487
Mailing Address - Country:US
Mailing Address - Phone:248-967-7000
Mailing Address - Fax:
Practice Address - Street 1:27351 DEQUINDRE
Practice Address - Street 2:
Practice Address - City:MADISON HGTS
Practice Address - State:MI
Practice Address - Zip Code:48071
Practice Address - Country:US
Practice Address - Phone:248-967-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085127283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital