Healthcare Provider Details

I. General information

NPI: 1710984117
Provider Name (Legal Business Name): MIDLAND NURSING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 E ASHMAN RD
MIDLAND MI
48642-8858
US

IV. Provider business mailing address

3615 E ASHMAN RD
MIDLAND MI
48642-8858
US

V. Phone/Fax

Practice location:
  • Phone: 989-631-0460
  • Fax: 989-631-0444
Mailing address:
  • Phone: 989-631-0460
  • Fax: 989-631-0444

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. MOHAMMAD A QAZI
Title or Position: CEO
Credential:
Phone: 248-386-0300