# MEDILODGE OF ST. CLAIR

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

## Provider details

- **NPI number:** 1427045442
- **Authorized official:** JANA STUEVER (ADMINISTRATOR)
- **Authorized official phone:** (810) 329-4736

## Contact information

- **Practice address:** 4220 HOSPITAL DR, EAST CHINA, MI 48054-2200
- **Practice address phone:** (810) 329-4736
- **Practice address fax:** (810) 329-6282
- **Mailing address:** 4220 HOSPITAL DR, EAST CHINA, MI 48054-2200
- **Mailing address phone:** (810) 329-4736
- **Mailing address fax:** (810) 329-6282

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 744040 | MI | Yes |

## Other

- **Enumeration date:** 10/04/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2630271 | — | MI |