# SHORELINE OPCO, LLC

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

## Provider details

- **NPI number:** 1801302187
- **Authorized official:** MR. STACEY PAUL ROGERS (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (502) 429-8062

## Contact information

- **Practice address:** 14900 SHORELINE DR, STERLING HEIGHTS, MI 48313-2251
- **Practice address phone:** (586) 247-4700
- **Practice address fax:** (586) 247-1499
- **Mailing address:** 7400 NEW LA GRANGE RD STE 100, LOUISVILLE, KY 40222-4870
- **Mailing address phone:** (502) 429-8062
- **Mailing address fax:** (502) 429-0650

## Taxonomy

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

## Other

- **Enumeration date:** 12/21/2017
- **Last updated:** 02/13/2018