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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
(248) 674-3431
Mailing address
930 RIDGEBROOK RD, SPARKS, MD 21152-9390
(410) 773-1000

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
4163588
MI
Enumeration date
10/07/2006
Last updated
12/20/2007
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