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NPI Code Detail

MEDICARE: CHRISTIAN PARK VILLAGE ACQUISITION COMPANY, LLC

MEDICARE: CHRISTIAN PARK VILLAGE ACQUISITION COMPANY, LLC
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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
209546OTHERBCBSM

General Provider Information

NPI Number : 1811994817
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHRISTIAN PARK VILLAGE ACQUISITION COMPANY, LLC
Provider Business Mailing Address
First Line : 2525 7TH AVE S
Second Line :
City : ESCANABA
State : MI
Zip : 49829-1131
Country : US
Telephone Number : 906-786-0408
Fax Number : 906-786-3277
Provider Business Practice Location Address
First Line : 2525 7TH AVE S
Second Line :
City : ESCANABA
State : MI
Zip : 49829-1131
Country : US
Telephone Number : 906-786-0408
Fax Number : 906-786-3277
Authorized Official
Title or Position : CEO
Name : MR. MOHAMMAD ASHRAF QAZI
Credential :
Telephone Number : 248-386-0300
Provider Enumeration Date : 07/05/2005
Last Update Date : 02/09/2010

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Directions to “CHRISTIAN PARK VILLAGE ACQUISITION COMPANY, LLC ” Practice Location

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