MEDICARE: CAMELOT HALL ACQUISITION COMPANY 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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	S9674	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1891792032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMELOT HALL ACQUISITION COMPANY INC

Provider Business Mailing Address
First Line	:	2209 N NEWBURGH RD
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-3373
Country	:	US
Telephone Number	:	734-522-1444
Fax Number	:	734-522-4690

Provider Business Practice Location Address
First Line	:	2209 N NEWBURGH RD
Second Line	:
City	:	WESTLAND
State	:	MI
Zip	:	48185-3373
Country	:	US
Telephone Number	:	734-522-1444
Fax Number	:	734-522-4690

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/26/2020

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