Provider Demographics
NPI:1942207006
Name:LAKEVIEW MANOR ACQUISITION COMPANY, INC.
Entity type:Organization
Organization Name:LAKEVIEW MANOR ACQUISITION COMPANY, 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 1:408 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9245
Mailing Address - Country:US
Mailing Address - Phone:989-362-2211
Mailing Address - Fax:989-984-0267
Practice Address - Street 1:408 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9245
Practice Address - Country:US
Practice Address - Phone:989-362-2211
Practice Address - Fax:989-984-0267
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIENA HEALTHCARE MANAGEMENT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-05
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4314664Medicaid
MIS9546OtherBCBSM
MI4314664Medicaid