Medilodge Of Port Huron

LBN: Port Huron Opco Llc
Medilodge Of Port Huron is an health care organization with primary practice located at 5635 Lakeshore Rd , Fort Gratiot MI 48059-2817. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Skilled Nursing Facility, which is considered as the primary health care specialty. Port Huron Opco Llc can be contacted via phone (810) 385-7447, or through Rogers, Stacey Paul via phone (502) 429-8062.

Contact Information

Primary practice address
5635 Lakeshore Rd Fort Gratiot MI 48059-2817
Phone: (810) 385-7447
Fax: (810) 385-7114
Website:
Map and Directions
Authorized official contact:
Name: Rogers, Stacey Paul
Phone: (502) 429-8062

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X

Profile Details

NPI number 1942641964
LBN Legal business name Port Huron Opco Llc
DBA Doing business as Medilodge Of Port Huron
Authorized official Rogers, Stacey Paul
Entity Organization
Organization subpart 1 No
Enumeration date Jul 8th, 2013
Last updated Dec 30th, 2014 - about 11 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942641964 NPPES
Michigan MEDICAID 1942641964

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