Healthcare Provider Details

I. General information

NPI: 1023199965
Provider Name (Legal Business Name): MACOMB OAKLAND REGIONAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 E WALTON BLVD
AUBURN HILLS MI
48326-1955
US

IV. Provider business mailing address

2399 E WALTON BLVD
AUBURN HILLS MI
48326-1955
US

V. Phone/Fax

Practice location:
  • Phone: 248-475-6300
  • Fax:
Mailing address:
  • Phone: 586-263-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BRENT WIRTH
Title or Position: PRESIDENT & CEO
Credential:
Phone: 248-475-6400