MEDICARE: EASTWOOD CONVALESCENT CENTER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S9533	OTHER	MI	BCBSM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629075023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTWOOD CONVALESCENT CENTER INC.

Provider Business Mailing Address
First Line	:	2295 E VERNOR HWY
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3513
Country	:	US
Telephone Number	:	313-923-5816
Fax Number	:	313-923-6155

Provider Business Practice Location Address
First Line	:	2295 E VERNOR HWY
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3513
Country	:	US
Telephone Number	:	313-923-5816
Fax Number	:	313-923-6155

Authorized Official
Title or Position	:	CEO
Name	:	MR. MOHAMMAD A QAZI
Credential	:
Telephone Number	:	248-386-0300

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	04/06/2020

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