Provider Demographics
NPI:1407102049
Name:NOTTING HILL OF WEST BLOOMFIELD, LLC
Entity Type:Organization
Organization Name:NOTTING HILL OF WEST BLOOMFIELD, LLC
Other - Org Name:NOTTING HILL OF WEST BLOOMFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
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 1:6535 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3147
Mailing Address - Country:US
Mailing Address - Phone:248-592-2000
Mailing Address - Fax:248-592-2600
Practice Address - Street 1:6535 DRAKE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3147
Practice Address - Country:US
Practice Address - Phone:248-592-2000
Practice Address - Fax:248-592-2600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIENA HEALTHCARE MANAGEMENT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-01
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
235663Medicare Oscar/Certification