Organization
MEDILODGE OF TAYLOR, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN DENEAN (CHIEF EXECUTIVE OFFICER)
(586) 752-5008
Entity
Organization
Contact information
Practice address
23600 NORTHLINE RD, TAYLOR, MI 48180-4620
(734) 287-8580
Mailing address
64500 VAN DYKE RD, WASHINGTON, MI 48095-2583
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
824360
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09998
BLUE CROSS OF MICHIGAN
MI
05
—
2695919
—
MI
Enumeration date
03/27/2006
Last updated
07/29/2008
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