Healthcare Provider Details

I. General information

NPI: 1619419272
Provider Name (Legal Business Name): JACKSON OPCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 W NORTH ST
JACKSON MI
49202-3313
US

IV. Provider business mailing address

4000 TOWN CTR STE 2000
SOUTHFIELD MI
48075-1415
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-3250
  • Fax:
Mailing address:
  • Phone: 248-386-0300
  • 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 A QAZI
Title or Position: MANAGER
Credential:
Phone: 248-386-0300