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Organization
PORT HURON OPCO LLC
Active
Organization
PORT HURON OPCO LLC
Active
Other names
MEDILODGE OF PORT HURON
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STACEY PAUL ROGERS (CHIEF FINANCIAL OFFICER)
(502) 429-8062
Entity
Organization
Contact information
Practice address
5635 LAKESHORE RD, FORT GRATIOT, MI 48059-2817
(810) 385-7447
(810) 385-7114
Mailing address
7400 NEW LA GRANGE RD, SUITE 100, LOUISVILLE, KY 40222-4870
(502) 429-8062
(502) 429-0650
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942641964
—
MI
Enumeration date
07/08/2013
Last updated
12/30/2014
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