Healthcare Provider Details

I. General information

NPI: 1043368558
Provider Name (Legal Business Name): COMMUNITY LIVING SERVICES OF OAKLAND COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

642 E. NINE MILE RD.
FERNDALE MI
48220
US

IV. Provider business mailing address

3270 GREENFIELD RD
BERKLEY MI
48072-1161
US

V. Phone/Fax

Practice location:
  • Phone: 248-547-2668
  • Fax: 248-547-3052
Mailing address:
  • Phone: 248-547-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANNETTE MARIE DOWNEY
Title or Position: EXECUTIVE DIRECTOR
Credential: LBSW, QIDP
Phone: 248-547-2668