# CHEBOYGAN OPCO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medilodge of Cheboygan, Medilodg of Cheboygan
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295251676
- **Authorized official:** KRISTINE RANEL KIRK (DELEGATED OFFICIAL)
- **Authorized official phone:** (417) 846-3521

## Contact information

- **Practice address:** 824 S HURON ST, CHEBOYGAN, MI 49721-2210
- **Practice address phone:** (231) 627-4347
- **Mailing address:** 7400 NEW LA GRANGE RD STE 400, LOUISVILLE, KY 40222-4870
- **Mailing address phone:** (502) 429-8062
- **Mailing address fax:** (866) 360-1098

## Taxonomy

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

## Other

- **Enumeration date:** 08/17/2017
- **Last updated:** 05/28/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1295251676 | — | MI |