Organization
GRAND HAVEN OPCO, LLC
Active
Other names
Medilodge at the Shore
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STACEY P ROGERS (CHIEF FINANCIAL OFFICER)
(502) 429-8062
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 100, LOUISVILLE, KY 40222-4870
(502) 429-8062
(502) 429-0650
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
06/27/2018
Last updated
07/16/2018
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