Organization
KALAMAZOO OPCO, LLC
Active
Other names
Medilodge of Kalamazoo
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
1701 S 11TH ST, KALAMAZOO, MI 49009-1775
(269) 375-2020
(269) 375-7990
Mailing address
7400 NEW LA GRANGE RD, SUITE 100, 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
—
1578960795
—
MI
Enumeration date
12/03/2014
Last updated
07/16/2015
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