Provider Demographics
NPI:1861825994
Name:OAKLAND LIVINGSTON HUMAN SERVICE AGENCY
Entity Type:Organization
Organization Name:OAKLAND LIVINGSTON HUMAN SERVICE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR FOR FINANCIAL COMPL
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:248-209-2632
Mailing Address - Street 1:196 CESAR E. CHAVEZ AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48343-0598
Mailing Address - Country:US
Mailing Address - Phone:248-209-2000
Mailing Address - Fax:
Practice Address - Street 1:196 CESAR E. CHAVEZ AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48343-0598
Practice Address - Country:US
Practice Address - Phone:248-209-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMICS12876251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable