Provider Demographics
NPI:1215934443
Name:ST JAMES NURSING & PHYSICAL REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:ST JAMES NURSING & PHYSICAL REHABILITATION CENTER, INC.
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 1:15063 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1332
Mailing Address - Country:US
Mailing Address - Phone:313-372-4065
Mailing Address - Fax:313-372-0999
Practice Address - Street 1:15063 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1332
Practice Address - Country:US
Practice Address - Phone:313-372-4065
Practice Address - Fax:313-372-0999
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
MI2737376Medicaid
MI09520OtherBCBSM
MI2737376Medicaid