# SOUTH HAVEN OPCO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medilodge of South Haven
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649855917
- **Authorized official:** JONATHAN OHLSEN JD (CHIEF LEGAL OFFICER)
- **Authorized official phone:** (541) 543-1215

## Contact information

- **Practice address:** 120 BASELINE RD, SOUTH HAVEN, MI 49090-1037
- **Practice address phone:** (269) 637-8411
- **Mailing address:** 7400 NEW LA GRANGE RD STE 100, LOUISVILLE, KY 40222-4870
- **Mailing address phone:** (502) 429-8062
- **Mailing address fax:** (502) 429-5980

## Taxonomy

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

## Other

- **Enumeration date:** 03/17/2021
- **Last updated:** 03/17/2021