Organization
TRAVERSE CITY OPCO GROUP, LLC
Active
Other names
Medilodge of Traverse City
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
2585 LAFRANIER RD, TRAVERSE CITY, MI 49686-8972
(231) 947-9511
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
08/28/2017
Last updated
08/28/2017
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