# MEDILODGE OF RICHMOND, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174583769
- **Authorized official:** KATHLEEN DENEAN (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (586) 752-5008

## Contact information

- **Practice address:** 34901 DIVISION RD, RICHMOND, MI 48062-1559
- **Practice address phone:** (586) 727-7562
- **Mailing address:** 64500 VAN DYKE RD, WASHINGTON, MI 48095-2583

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 504160 | MI | Yes |

## Other

- **Enumeration date:** 03/27/2006
- **Last updated:** 07/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 09908 | BLUE CROSS OF MICHIGAN | MI |
| 05 | — | 2152422 | — | MI |