Healthcare Provider Details

I. General information

NPI: 1912496324
Provider Name (Legal Business Name): REGENCY AT INDEPENDENCE TOWNSHIP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6211 STONEWOOD DRIVE
CLARKSTON MI
48346
US

IV. Provider business mailing address

4000 TOWN CTR STE 700
SOUTHFIELD MI
48075-1424
US

V. Phone/Fax

Practice location:
  • Phone: 248-262-2357
  • Fax:
Mailing address:
  • Phone: 248-262-2357
  • 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: MOHAMMAD QAZI
Title or Position: MANAGER/OWNER
Credential:
Phone: 248-262-2357