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Organization
GRAND HAVEN OPCO LLC
Active
Organization
GRAND HAVEN OPCO LLC
Active
Other names
Medilodge at the Shore
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE RANEL KIRK (DELEGATED OFFICIAL)
(417) 846-3521
Entity
Organization
Contact information
Practice address
900 S BEACON BLVD, GRAND HAVEN, MI 49417
(616) 846-1850
Mailing address
7400 NEW LA GRANGE RD STE 400, LOUISVILLE, KY 40222-4870
(502) 429-8062
(866) 360-1098
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770078263
—
MI
Enumeration date
06/27/2018
Last updated
05/28/2026
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