Healthcare Provider Details

I. General information

NPI: 1295407955
Provider Name (Legal Business Name): OAKTOWN COMMUNITY HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 LUTHER AVE
PONTIAC MI
48341-2572
US

IV. Provider business mailing address

653 BAGLEY ST
PONTIAC MI
48341-2612
US

V. Phone/Fax

Practice location:
  • Phone: 248-289-2243
  • Fax:
Mailing address:
  • Phone: 248-289-2243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DYMOND / LAMEKA FOWLER / BRITTON
Title or Position: MANAGERS
Credential: CNA
Phone: 248-289-2243