MEDICARE: SORRENTO CARE CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	09570	OTHER		BCBSM

General Provider Information

NPI Number	:	1629039631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SORRENTO CARE CENTER, LLC

Provider Business Mailing Address
First Line	:	12900 W CHICAGO ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-2651
Country	:	US
Telephone Number	:	313-491-7830
Fax Number	:

Provider Business Practice Location Address
First Line	:	12900 W CHICAGO ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48228-2651
Country	:	US
Telephone Number	:	313-491-7830
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MOHAMMAD A QAZI
Credential	:
Telephone Number	:	248-386-0300

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	03/30/2010

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Directions to “SORRENTO CARE CENTER, LLC ” Practice Location

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