=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427099472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF OAKLAND
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2006
-----------------------------------------------------
Last Update Date | 06/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 N TELEGRAPH RD BLDG. 34 EAST
-----------------------------------------------------
City | PONTIAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48341-0432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-858-1415
-----------------------------------------------------
Fax | 248-858-4026
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 N TELEGRAPH RD BLDG. 34 EAST
-----------------------------------------------------
City | PONTIAC
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48341-0432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-858-1415
-----------------------------------------------------
Fax | 248-858-4026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. GEORGE J. MILLER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-858-1293
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 638510
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------