Provider Demographics
NPI:1710984117
Name:MIDLAND NURSING CENTER LLC
Entity Type:Organization
Organization Name:MIDLAND NURSING CENTER LLC
Other - Org Name:BRITTANY MANOR
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 1:3615 E ASHMAN RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-8858
Mailing Address - Country:US
Mailing Address - Phone:989-631-0460
Mailing Address - Fax:989-631-0444
Practice Address - Street 1:3615 E ASHMAN RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-8858
Practice Address - Country:US
Practice Address - Phone:989-631-0460
Practice Address - Fax:989-631-0444
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:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS9508OtherBCBSM
MI2153288Medicaid
235245Medicare Oscar/Certification