Provider Demographics
NPI:1871590018
Name:FOUR SEASONS NURSING CENTER LLC
Entity type:Organization
Organization Name:FOUR SEASONS NURSING CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:ASHRAF
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-386-0300
Mailing Address - Street 1:PO BOX 303
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-0303
Mailing Address - Country:US
Mailing Address - Phone:989-269-9983
Mailing Address - Fax:989-269-6361
Practice Address - Street 1:1167 E HOPSON ST
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-1555
Practice Address - Country:US
Practice Address - Phone:989-269-9983
Practice Address - Fax:989-269-6361
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIENA HEALTHCARE MANAGEMENT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-01
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS9514OtherBCBSM
MI4152646Medicaid
235456Medicare Oscar/Certification