Provider Demographics
NPI:1699772087
Name:BLOOMFIELD ORCHARD ACQUISITION COMPANY, INC
Entity type:Organization
Organization Name:BLOOMFIELD ORCHARD ACQUISITION COMPANY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:QAZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-386-0300
Mailing Address - Street 1:7277 RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1266
Mailing Address - Country:US
Mailing Address - Phone:248-360-4443
Mailing Address - Fax:248-366-6469
Practice Address - Street 1:7277 RICHARDSON RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-1266
Practice Address - Country:US
Practice Address - Phone:248-360-4443
Practice Address - Fax:248-366-6469
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIENA HEALTHCARE MANAGEMENT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-30
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4321364Medicaid
MIS9545OtherBCBSM
235562Medicare Oscar/Certification