Healthcare Provider Details

I. General information

NPI: 1699772087
Provider Name (Legal Business Name): BLOOMFIELD ORCHARD ACQUISITION COMPANY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7277 RICHARDSON RD
WEST BLOOMFIELD MI
48323-1266
US

IV. Provider business mailing address

7277 RICHARDSON RD
WEST BLOOMFIELD MI
48323-1266
US

V. Phone/Fax

Practice location:
  • Phone: 248-360-4443
  • Fax: 248-366-6469
Mailing address:
  • Phone: 248-360-4443
  • Fax: 248-366-6469

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: CEO
Credential:
Phone: 248-386-0300