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General NPI Number Information
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NPI Number | 1619419272
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Entity Type | Organization
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Legal Business Name | JACKSON OPCO, LLC
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Dates
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Enumeration Date | 11/14/2016
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 434 W NORTH ST
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City | JACKSON
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State | MI
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Zip | 49202-3313
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Country | US
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Telephone | 517-787-3250
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 TOWN CTR STE 2000
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City | SOUTHFIELD
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State | MI
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Zip | 48075-1415
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Country | US
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Telephone | 248-386-0300
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MOHAMMAD A QAZI
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Credential |
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Telephone | 248-386-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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