Provider Demographics
NPI:1023283686
Name:TRILOGY HEALTHCARE OF OAKLAND, LLC
Entity type:Organization
Organization Name:TRILOGY HEALTHCARE OF OAKLAND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP - FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:PLEVYAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:502-213-1710
Mailing Address - Street 1:10735 BOGIE LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-2426
Mailing Address - Country:US
Mailing Address - Phone:248-363-9400
Mailing Address - Fax:248-363-8028
Practice Address - Street 1:10735 BOGIE LAKE ROAD
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48382-2426
Practice Address - Country:US
Practice Address - Phone:248-363-9400
Practice Address - Fax:248-363-8028
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY HEALTH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-24
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI63-4410314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2082248Medicaid
MI2082248Medicaid