# HOLLAND OPCO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medilodge of Holland
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225435449
- **Authorized official:** MR. STACEY PAUL ROGERS (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (502) 429-8062

## Contact information

- **Practice address:** 1221 E 16TH ST, HOLLAND, MI 49423-9127
- **Practice address phone:** (616) 396-7095
- **Practice address fax:** (616) 396-7157
- **Mailing address:** 7400 NEW LA GRANGE RD, LOUISVILLE, KY 40222-4870
- **Mailing address phone:** (502) 429-8062
- **Mailing address fax:** (502) 429-0650

## Taxonomy

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

## Other

- **Enumeration date:** 12/03/2014
- **Last updated:** 07/16/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1225435449 | — | MI |