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Organization
MEDILODGE OF HILLMAN LLC
Active
Organization
MEDILODGE OF HILLMAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN DENEAN (CHIEF EXECUTIVC OFFICER)
(586) 752-5008
Entity
Organization
Contact information
Practice address
631 CARING ST, HILLMAN, MI 49746-8818
(989) 742-4581
Mailing address
64500 VAN DYKE RD, WASHINGTON, MI 48095-2583
(586) 752-5008
(586) 752-7609
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
604010
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4147350
—
MI
01
—
S9502
BLUE CROSS OF MICHIGAN
MI
Enumeration date
02/08/2006
Last updated
05/01/2008
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