Provider Demographics
NPI:1679580864
Name:OAKWOOD HOME CARE SERVICES
Entity type:Organization
Organization Name:OAKWOOD HOME CARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SOUPIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:313-996-3023
Mailing Address - Street 1:1633 FAIRLANE CIRCLE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-3660
Mailing Address - Country:US
Mailing Address - Phone:800-757-7711
Mailing Address - Fax:313-996-3102
Practice Address - Street 1:1633 FAIRLANE CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-3660
Practice Address - Country:US
Practice Address - Phone:800-757-7711
Practice Address - Fax:313-996-3102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI237211OtherHAP
MI127837OtherGREAT LAKES HEALTH
MI000000003409OtherCAPE HEALTH
MIOE115OtherBLUE CROSS
MI2598361Medicaid
MIHH820004OtherM-CARE
MIOE115OtherBLUE CARE NETWORK
MI111432OtherCARE CHOICES
MI237211Medicare ID - Type UnspecifiedMEDICARE ID NUMBER