Organization
IHS ACQUISITION NO 111, INC.
Active
Other names
Clarkston Specialty Healthcare Center
Organization subpart
No
Provider details
NPI number
Authorized official
MAGGIE CANNY (PRESIDENT)
(248) 674-0903
Entity
Organization
Contact information
Practice address
4800 CLINTONVILLE RD, CLARKSTON, MI 48346-4297
(248) 674-0903
Mailing address
930 RIDGEBROOK ROAD, SPARKS, MD 21152
(410) 773-1000
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
634023
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4608402
—
MI
Enumeration date
06/07/2007
Last updated
10/02/2007
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