Healthcare Provider Details

I. General information

NPI: 1457881997
Provider Name (Legal Business Name): OAKVILLE CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16250 NORTHLAND DR STE 315
SOUTHFIELD MI
48075-5228
US

IV. Provider business mailing address

PO BOX 700627
PLYMOUTH MI
48170-0951
US

V. Phone/Fax

Practice location:
  • Phone: 248-513-5360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AUSTIN DERRICK ROGERS
Title or Position: OWNER
Credential:
Phone: 248-659-7403