Provider Demographics
NPI:1669479895
Name:ST. MARY'S ACQUISITION COMPANY INC
Entity Type:Organization
Organization Name:ST. MARY'S ACQUISITION COMPANY INC
Other - Org Name:REGENCY AT ST. CLAIR SHORES
Other - Org Type:Doing Business As
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 1:4000 TOWN CTR STE 2000
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-1415
Mailing Address - Country:US
Mailing Address - Phone:248-262-2357
Mailing Address - Fax:586-772-6608
Practice Address - Street 1:22700 GREATER MACK AVENUE
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1917
Practice Address - Country:US
Practice Address - Phone:586-443-4910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS9553OtherBCBSM PIN
MI4321453Medicaid
235319Medicare Oscar/Certification