Organization
GRAND HAVEN OPCO LLC
Active
Other names
Medilodge at the Shore
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE RANEL KIRK (DELEGATED OFFICIAL)
(417) 846-3521
Entity
Organization
Contact information
Practice address
900 S BEACON BLVD, GRAND HAVEN, MI 49417
(616) 846-1850
Mailing address
7400 NEW LA GRANGE RD STE 400, LOUISVILLE, KY 40222-4870
(502) 429-8062
(866) 360-1098
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770078263
—
MI
Enumeration date
06/27/2018
Last updated
05/28/2026
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