Healthcare Provider Details

I. General information

NPI: 1275155137
Provider Name (Legal Business Name): OAKLAND LIMITED DIVIDEND HOUSING ASSOCIATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2020
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1915 BALDWIN AVE
PONTIAC MI
48340-1173
US

IV. Provider business mailing address

1915 BALDWIN AVE
PONTIAC MI
48340-1173
US

V. Phone/Fax

Practice location:
  • Phone: 248-335-7020
  • Fax: 248-335-0141
Mailing address:
  • Phone: 248-335-7020
  • Fax: 248-335-0141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: CHRIS VOGT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 248-335-7020