# FARMINGTON OPCO LLC

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

## Provider details

- **NPI number:** 1255796512
- **Authorized official:** MR. STACEY PAUL ROGERS (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (502) 429-8062

## Contact information

- **Practice address:** 34225 GRAND RIVER AVE, FARMINGTON, MI 48335-3440
- **Practice address phone:** (248) 477-7373
- **Practice address fax:** (248) 477-2888
- **Mailing address:** 7400 NEW LA GRANGE RD STE 100, 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:** 12/30/2015
- **Last updated:** 12/30/2015