Provider Demographics
NPI:1861666265
Name:OAKWOOD HEALTHCARE, INC
Entity Type:Organization
Organization Name:OAKWOOD HEALTHCARE, INC
Other - Org Name:OAKWOOD HEALTHCARE SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT SHARED SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ODOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:947-522-3326
Mailing Address - Street 1:26901 BEAUMONT BLVD.
Mailing Address - Street 2:COMPLIANCE
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-4716
Mailing Address - Country:US
Mailing Address - Phone:947-522-1963
Mailing Address - Fax:
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-586-5011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X
MI820120282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No282N00000XHospitalsGeneral Acute Care HospitalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI006403OtherMIDWEST
MI6330275OtherAETNA PROVIDER#
MI104641OtherCARE CHOICE
MI000000001513OtherCAPE HEALTH PLAN
MI49342OtherOMNICARE CONVENTRY
MIP00205OtherBCN PROVIDER #
MI101520OtherCHS WELLNESS
MI118626OtherGREATLAKES HEALTH PLAN
MI00205OtherBCBS PROV #
MI40205OtherBCBS SPRINGWELLS PROV #
MI000000001513OtherCAPE HEALTH PLAN