Healthcare Provider Details

I. General information

NPI: 1669479895
Provider Name (Legal Business Name): ST. MARY'S ACQUISITION COMPANY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22700 GREATER MACK AVENUE
ST CLAIR SHORES MI
48080-1917
US

IV. Provider business mailing address

4000 TOWN CTR STE 2000
SOUTHFIELD MI
48075-1415
US

V. Phone/Fax

Practice location:
  • Phone: 586-443-4910
  • Fax:
Mailing address:
  • Phone: 248-262-2357
  • Fax: 586-772-6608

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 ASHRAF QAZI
Title or Position: CEO
Credential:
Phone: 248-386-0300