Provider Demographics
NPI:1629075023
Name:EASTWOOD CONVALESCENT CENTER INC.
Entity Type:Organization
Organization Name:EASTWOOD CONVALESCENT CENTER INC.
Other - Org Name:REGENCY AT CHENE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
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 1:2295 E VERNOR HWY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-3513
Mailing Address - Country:US
Mailing Address - Phone:313-923-5816
Mailing Address - Fax:313-923-6155
Practice Address - Street 1:2295 E VERNOR HWY
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-3513
Practice Address - Country:US
Practice Address - Phone:313-923-5816
Practice Address - Fax:313-923-6155
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:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS9533OtherBCBSM
MI3302112Medicaid
235422Medicare Oscar/Certification