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Organization
SOUTH HAVEN OPCO, LLC
Active
Organization
SOUTH HAVEN OPCO, LLC
Active
Other names
Medilodge of South Haven
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN OHLSEN JD (CHIEF LEGAL OFFICER)
(541) 543-1215
Entity
Organization
Contact information
Practice address
120 BASELINE RD, SOUTH HAVEN, MI 49090-1037
(269) 637-8411
Mailing address
7400 NEW LA GRANGE RD STE 100, LOUISVILLE, KY 40222-4870
(502) 429-8062
(502) 429-5980
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
03/17/2021
Last updated
03/17/2021
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