# GRAND BLANC OPCO LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medilodge of Grand Blanc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790180255
- **Authorized official:** MR. STACEY PAUL ROGERS (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (502) 429-0650

## Contact information

- **Practice address:** 11941 BELSAY RD, GRAND BLANC, MI 48439-1702
- **Practice address phone:** (810) 694-1970
- **Practice address fax:** (810) 694-4081
- **Mailing address:** 7400 NEW LA GRANGE RD STE 400, LOUISVILLE, KY 40222-4870
- **Mailing address phone:** (502) 429-8062

## Taxonomy

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

## Other

- **Enumeration date:** 10/27/2014
- **Last updated:** 07/01/2025