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Organization

TAWAS CITY OPCO, LLC

Active
Other names
Medilodge of Tawas 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
400 NORTH ST W, TAWAS CITY, MI 48763-9161
(989) 362-8645
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

Other identifiers
Code
Description
Identifier
Issuer
State
05
1508383837
MI
Enumeration date
08/28/2017
Last updated
02/06/2019
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