Provider Demographics
NPI:1891792032
Name:CAMELOT HALL ACQUISITION COMPANY INC
Entity Type:Organization
Organization Name:CAMELOT HALL ACQUISITION COMPANY INC
Other - Org Name:CAMELOT HALL CONVALESCENT CENTER
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 1:2209 N NEWBURGH RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-3373
Mailing Address - Country:US
Mailing Address - Phone:734-522-1444
Mailing Address - Fax:734-522-4690
Practice Address - Street 1:2209 N NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-3373
Practice Address - Country:US
Practice Address - Phone:734-522-1444
Practice Address - Fax:734-522-4690
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CIENA HEALTHCARE MANAGEMENT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-01
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4321417Medicaid
MIS9674OtherBCBSM
235655Medicare Oscar/Certification