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NPI Code Detail

MEDICARE: FOUR SEASONS NURSING CENTER LLC

MEDICARE: FOUR SEASONS NURSING 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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1S9514OTHERMIBCBSM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871590018
Entity Type Code : Organization
Provider Name (Legal Business Name) : FOUR SEASONS NURSING CENTER LLC
Provider Business Mailing Address
First Line : PO BOX 303
Second Line :
City : BAD AXE
State : MI
Zip : 48413-0303
Country : US
Telephone Number : 989-269-9983
Fax Number : 989-269-6361
Provider Business Practice Location Address
First Line : 1167 E HOPSON ST
Second Line :
City : BAD AXE
State : MI
Zip : 48413-1555
Country : US
Telephone Number : 989-269-9983
Fax Number : 989-269-6361
Authorized Official
Title or Position : CEO
Name : MR. MOHAMMAD ASHRAF QAZI
Credential :
Telephone Number : 248-386-0300
Provider Enumeration Date : 07/01/2005
Last Update Date : 02/09/2010

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Directions to “FOUR SEASONS NURSING CENTER LLC ” Practice Location

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