Healthcare Provider Details

I. General information

NPI: 1881201879
Provider Name (Legal Business Name): OXFORD RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 10/23/2020
Certification Date: 10/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7030 WHITMORE LAKE RD
BRIGHTON MI
48116-8533
US

IV. Provider business mailing address

7030 WHITMORE LAKE RD
BRIGHTON MI
48116-8533
US

V. Phone/Fax

Practice location:
  • Phone: 248-486-3636
  • Fax: 248-486-0686
Mailing address:
  • Phone: 248-486-3636
  • Fax: 248-486-0686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMELA OXFORD PETERSON
Title or Position: CEO
Credential:
Phone: 248-486-3636