# MEDILODGE OF YALE INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MEDILODGE OF YALE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871553495
- **Authorized official:** MR. STACEY PAUL ROGERS (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (502) 429-8062

## Contact information

- **Practice address:** 90 JEAN ST, YALE, MI 48097-2932
- **Practice address phone:** (810) 387-3226
- **Practice address fax:** (810) 387-3050
- **Mailing address:** 7400 NEW LA GRANGE RD, SUITE 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:** 03/27/2006
- **Last updated:** 12/30/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1871553495 | — | MI |