Organization
SOUTH HAVEN OPCO, LLC
Active
Other names
Medilodge of South Haven
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN OHLSEN JD (CHIEF LEGAL OFFICER)
(541) 543-1215
Entity
Organization
Contact information
Practice address
120 BASELINE RD, SOUTH HAVEN, MI 49090-1037
(269) 637-8411
Mailing address
7400 NEW LA GRANGE RD STE 100, LOUISVILLE, KY 40222-4870
(502) 429-8062
(502) 429-5980
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
03/17/2021
Last updated
03/17/2021
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