Basic Information
| Provider Information | |||||||||
| NPI: | 1306854666 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OAKWOOD HEALTH PROMOTIONS, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BEAUMONT REHABILITATION & CONTINUING CARE, DEARBORN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26901 BEAUMONT BLVD. | ||||||||
| Address2: | COMPLIANCE | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480334616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9475221963 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16391 ROTUNDA DR | ||||||||
| Address2: | |||||||||
| City: | DEARBORN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481201172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3132539600 | ||||||||
| FaxNumber: | 3132539035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 10/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | ODOM | ||||||||
| AuthorizedOfficialFirstName: | LEE | ||||||||
| AuthorizedOfficialMiddleName: | ANN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT SHARED SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 9475223326 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 82-4022 | MI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2741252 | 05 | MI | MEDICAID | 00000005083A | 01 | MI | CAPE HEALTH | OTHER | SN820008 | 01 | MI | M-CARE | OTHER | 2588801 | 01 | MI | CIGNA | OTHER | 4437126 | 01 | MI | AETNA | OTHER |