Organization
GAYLORD OPCO, LLC
Active
Other names
Medilodge of Gaylord
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
508 RANDOM LN, GAYLORD, MI 49735-9304
(989) 732-3508
Mailing address
7400 NEW LA GRANGE RD STE 100, LOUISVILLE, KY 40222-4870
(502) 429-8062
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
08/29/2017
Last updated
08/29/2017
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