Healthcare Provider Details

I. General information

NPI: 1366807133
Provider Name (Legal Business Name): OAKLAND MANOR SKILLED NURSING AND SUB-AC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30700 TELEGRAPH RD STE 2504
BINGHAM FARMS MI
48025-4524
US

IV. Provider business mailing address

30700 TELEGRAPH RD STE 2504
BINGHAM FARMS MI
48025-4524
US

V. Phone/Fax

Practice location:
  • Phone: 248-593-1990
  • Fax: 248-593-9120
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number847384
License Number StateMI

VIII. Authorized Official

Name: DIANA FOX
Title or Position: ADMISSIONS
Credential:
Phone: 248-593-1990