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General NPI Number Information
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NPI Number | 1508004631
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Entity Type | Organization
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Legal Business Name | OAKWOOD HERITAGE HOOSPITAL
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Dates
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Enumeration Date | 01/27/2009
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Last Update Date | 01/27/2009
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Provider Practice Location Address
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Address Line | 27350 EVERGREEN RD
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-3279
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Country | US
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Telephone | 734-883-5535
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Fax |
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Provider Business Mailing Address
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Address Line | 27350 EVERGREEN RD
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City | LATHRUP VILLAGE
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State | MI
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Zip | 48076-3279
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Country | US
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Telephone | 734-883-5535
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Fax |
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Authorized Official
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Title or Position | PSYCH
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Name | MS. JINETTE JADE DUMONT
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Credential | LMSW
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Telephone | 734-883-5535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 6801089804
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License Number State | MI
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