# MEDILODGE OF HILLMAN LLC

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

## Provider details

- **NPI number:** 1437122801
- **Authorized official:** KATHLEEN DENEAN (CHIEF EXECUTIVC OFFICER)
- **Authorized official phone:** (586) 752-5008

## Contact information

- **Practice address:** 631 CARING ST, HILLMAN, MI 49746-8818
- **Practice address phone:** (989) 742-4581
- **Mailing address:** 64500 VAN DYKE RD, WASHINGTON, MI 48095-2583
- **Mailing address phone:** (586) 752-5008
- **Mailing address fax:** (586) 752-7609

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 604010 | MI | Yes |

## Other

- **Enumeration date:** 02/08/2006
- **Last updated:** 05/01/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4147350 | — | MI |
| 01 | — | S9502 | BLUE CROSS OF MICHIGAN | MI |