Provider Demographics
NPI:1871027896
Name:OAKTREE COMMUNITY & SOCIAL GROWTH
Entity Type:Organization
Organization Name:OAKTREE COMMUNITY & SOCIAL GROWTH
Other - Org Name:OCSG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRISTAM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:SR
Authorized Official - Credentials:MS SST QMHP CMHP
Authorized Official - Phone:248-296-0359
Mailing Address - Street 1:1900 JOLIET ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-4856
Mailing Address - Country:US
Mailing Address - Phone:248-296-0359
Mailing Address - Fax:810-259-0359
Practice Address - Street 1:5103 W PIERSON RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-1395
Practice Address - Country:US
Practice Address - Phone:810-391-2923
Practice Address - Fax:810-391-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6803806719251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management