Organization
HOLLAND OPCO, LLC
Active
Other names
Medilodge of Holland
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
1221 E 16TH ST, HOLLAND, MI 49423-9127
(616) 396-7095
(616) 396-7157
Mailing address
7400 NEW LA GRANGE RD, 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
—
1225435449
—
MI
Enumeration date
12/03/2014
Last updated
07/16/2015
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