Provider Demographics
NPI:1730700949
Name:WATERFORD OAKS SENIOR CARE INC
Entity type:Organization
Organization Name:WATERFORD OAKS SENIOR CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-390-6602
Mailing Address - Street 1:3385 PONTIAC LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-2538
Mailing Address - Country:US
Mailing Address - Phone:248-890-8144
Mailing Address - Fax:
Practice Address - Street 1:3385 PONTIAC LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-2538
Practice Address - Country:US
Practice Address - Phone:248-890-8144
Practice Address - Fax:248-682-6799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility