Organization
PORT HURON OPCO LLC
Active
Other names
MEDILODGE OF PORT HURON
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STACEY PAUL ROGERS (CHIEF FINANCIAL OFFICER)
(502) 429-8062
Entity
Organization
Contact information
Practice address
5635 LAKESHORE RD, FORT GRATIOT, MI 48059-2817
(810) 385-7447
(810) 385-7114
Mailing address
7400 NEW LA GRANGE RD, SUITE 100, LOUISVILLE, KY 40222-4870
(502) 429-8062
(502) 429-0650
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942641964
—
MI
Enumeration date
07/08/2013
Last updated
12/30/2014
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