# MEDILODGE OF PORT HURON, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891955720
- **Authorized official:** KATHLEEN DENEAN (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (586) 752-5008

## Contact information

- **Practice address:** 5635 LAKESHORE RD, FORT GRATIOT, MI 48059-2817
- **Practice address phone:** (810) 385-7447
- **Mailing address:** 5635 LAKESHORE RD, FORT GRATIOT, MI 48059-2817

## Taxonomy

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

## Other

- **Enumeration date:** 06/13/2008
- **Last updated:** 06/13/2008