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General NPI Number Information
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NPI Number | 1306661616
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Entity Type | Organization
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Legal Business Name | CCS-OAKLAND LLC
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Dates
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Enumeration Date | 11/21/2024
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 45211 HELM ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-6023
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Country | US
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Telephone | 734-525-9712
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Fax |
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Provider Business Mailing Address
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Address Line | 45211 HELM ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-6023
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Country | US
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Telephone | 734-525-9712
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICIA FANELLI
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Credential | CCP
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Telephone | 734-525-9712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246Z00000X
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Taxonomy Name | Other Specialist/Technologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 247000000X
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Taxonomy Name | Health Information Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 242T00000X
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Taxonomy Name | Perfusionist
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License Number |
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License Number State |
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