# IHS ACQUISITION NO. 111, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Clarkston Specialty Healthcare Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508953787
- **Authorized official:** MAGGIE CANNY (PRESIDENT)
- **Authorized official phone:** (248) 674-0903

## Contact information

- **Practice address:** 4800 CLINTONVILLE RD, CLARKSTON, MI 48346-4297
- **Practice address phone:** (248) 674-0903
- **Practice address fax:** (248) 674-3431
- **Mailing address:** 930 RIDGEBROOK RD, SPARKS, MD 21152-9390
- **Mailing address phone:** (410) 773-1000

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 10/07/2006
- **Last updated:** 12/20/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4163588 | — | MI |