Healthcare Provider Details

I. General information

NPI: 1447542857
Provider Name (Legal Business Name): MANORS OF CANTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45900 GEDDES RD
CANTON MI
48188-2306
US

IV. Provider business mailing address

45900 GEDDES RD
CANTON MI
48188-2306
US

V. Phone/Fax

Practice location:
  • Phone: 248-386-0300
  • Fax: 248-386-1652
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MOHAMMED A QAZI
Title or Position: CEO/PRESIDENT
Credential:
Phone: 248-386-0300