Organization
MEDILODGE OF PORT HURON, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN DENEAN (CHIEF EXECUTIVE OFFICER)
(586) 752-5008
Entity
Organization
Contact information
Practice address
5635 LAKESHORE RD, FORT GRATIOT, MI 48059-2817
(810) 385-7447
Mailing address
5635 LAKESHORE RD, FORT GRATIOT, MI 48059-2817
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
06/13/2008
Last updated
06/13/2008
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