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Organization
MEDILODGE OF ROYAL OAK
Active
Organization
MEDILODGE OF ROYAL OAK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN KUEPPERS (CHIEF FINANCIAL OFFICER)
(586) 752-5008
Entity
Organization
Contact information
Practice address
3030 GREENFIELD RD, ROYAL OAK, MI 48073-6528
(248) 288-6610
Mailing address
64500 VAN DYKE RD, WASHINGTON, MI 48095-2583
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
634360
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09982
BLUE CROSS OF MICHIGAN
MI
05
—
2695973
—
MI
Enumeration date
03/27/2006
Last updated
08/22/2020
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