Organization
MEDILODGE OF PLYMOUTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN DENEAN (CHIEF EXECUTIVE OFFICER)
(586) 752-5008
Entity
Organization
Contact information
Practice address
395 W ANN ARBOR TRL, PLYMOUTH, MI 48170-1641
(734) 453-3983
(734) 414-8231
Mailing address
395 W ANN ARBOR TRL, PLYMOUTH, MI 48170-1641
(734) 453-3983
(734) 414-8231
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
824320
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09839
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
05
—
3453224
—
MI
Enumeration date
01/31/2006
Last updated
07/16/2009
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