=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821666405
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST OAKLAND HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2021
-----------------------------------------------------
Last Update Date | 08/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 56849 GRAND RIVER AVE STE 13
-----------------------------------------------------
City | NEW HUDSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48165-9564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-377-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 56849 GRAND RIVER AVE STE 13
-----------------------------------------------------
City | NEW HUDSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48165-9564
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-377-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. BENJAMIN BOWERMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-377-8300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------