NPIMap

Organization Active NPI

Oakwood Youth Programs, LLC

  • Physical Medicine & Rehabilitation Physician
  • Dearborn, MI
National Provider Identifier
1790959120
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
4301061207 Issued in MI
Legal business name
OAKWOOD YOUTH PROGRAMS, LLC
Doing business as
Oakwood Youth Programs, LLc
Practice address
18501 Rotunda Dr
Ste 200
Dearborn, MI 48124-3891
Phone
(313) 996-1960
NPI assigned
Apr 16, 2008
Last updated
Oct 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lee Ann Odom
Title
President Shared Services
Phone
(947) 522-3326

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X 4301061207 MI Primary

Addresses

Primary practice location

18501 Rotunda Dr
Ste 200
Dearborn, MI 48124-3891

Mailing address

26901 Beaumont Blvd
Compliance
Southfield, MI 48033-3849
Phone (947) 522-1964

Other names 1

  • Oakwood Youth Programs, LLc Doing business as

National Provider Directory

National Provider Directory

Locations

9650 Wayne Rd
#Teen
Romulus, MI 48174
Phone (734) 941-1400

26650 Eureka Rd
Ste C
Taylor, MI 48180
Phone (734) 941-4991

Practitioners & affiliated clinicians

Practitioners 36

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 36

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634774400000",
    "number": "1790959120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD",
            "address_2": "COMPLIANCE",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849",
            "telephone_number": "947-522-1964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18501 ROTUNDA DR",
            "address_2": "STE 200",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481243891",
            "telephone_number": "313-996-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKWOOD YOUTH PROGRAMS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-16",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A",
        "authorized_official_last_name": "ODOM",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT SHARED SERVICES",
        "authorized_official_telephone_number": "947-522-3326"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301061207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oakwood Youth Programs, LLc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oakwood Youth Programs, LLc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.