MEDICARE: LAKEVIEW MANOR ACQUISITION COMPANY, INC.

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	S9546	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1942207006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEVIEW MANOR ACQUISITION COMPANY, INC.

Provider Business Mailing Address
First Line	:	408 N 5TH AVE
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9245
Country	:	US
Telephone Number	:	989-362-2211
Fax Number	:	989-984-0267

Provider Business Practice Location Address
First Line	:	408 N 5TH AVE
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9245
Country	:	US
Telephone Number	:	989-362-2211
Fax Number	:	989-984-0267

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	05/24/2013

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