Healthcare Provider Details

I. General information

NPI: 1831278134
Provider Name (Legal Business Name): OAKLAND GERIATRIC VILLAGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W SILVERBELL RD
ORION MI
48359-1345
US

IV. Provider business mailing address

11700 E 10 MILE RD
WARREN MI
48089-3903
US

V. Phone/Fax

Practice location:
  • Phone: 248-391-0900
  • Fax: 248-391-4019
Mailing address:
  • Phone: 586-759-5966
  • Fax: 586-759-8006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number634160
License Number StateMI

VIII. Authorized Official

Name: MR. DONALD JAMES BORTZ
Title or Position: PRESIDENT
Credential:
Phone: 586-759-5966