Medilodge of Plymouth, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

824320 Issued in MI

Legal business name

MEDILODGE OF PLYMOUTH, INC.

Practice address

395 W Ann Arbor TRL
Plymouth, MI 48170-1641

Phone

(734) 453-3983

Fax

(734) 414-8231

NPI assigned

Jan 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathleen Denean

Title

Chief Executive Officer

Phone

(586) 752-5008

Specialties & licenses 1

Addresses

Other identifiers 2

Tax ID family

Medilodge of Plymouth2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Plymouth Opco LLC

  • Skilled Nursing Facility
  • Plymouth, MI
  • NPI 1326489634
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247702400000",
    "number": "1003887662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "395 W ANN ARBOR TRL",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481701641",
            "telephone_number": "734-453-3983",
            "fax_number": "734-414-8231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W ANN ARBOR TRL",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481701641",
            "telephone_number": "734-453-3983",
            "fax_number": "734-414-8231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDILODGE OF PLYMOUTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2009-07-16",
        "status": "A",
        "authorized_official_last_name": "DENEAN",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "586-752-5008"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "824320",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3453224",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
            "identifier": "09839",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aurolee Sharon Meadow, PH.D.
• Meahan Therapy Inc
• Sharon Ann Meahan, LMSW
• Casey Mears
• Medical One Transportation
• Daniel Medina
• Nicolas Medina
• Margaret Leslie Medlen, OTR
• Jordyn Meersserman
• Kerry Meggison, OTRL

• Skilled Nursing Facility in Plymouth, MI
• Providers in Plymouth, MI by specialty
• Skilled Nursing Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.