Healthcare Provider Details

I. General information

NPI: 1669808622
Provider Name (Legal Business Name): MAPLE-DRAKE REAL ESTATE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 DRAKE RD
WEST BLOOMFIELD MI
48322-3147
US

IV. Provider business mailing address

6535 DRAKE RD
WEST BLOOMFIELD MI
48322-3147
US

V. Phone/Fax

Practice location:
  • Phone: 248-592-2000
  • Fax: 248-592-2600
Mailing address:
  • Phone: 248-592-2000
  • Fax: 248-592-2600

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