Gaylord Opco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

GAYLORD OPCO, LLC

Practice address

508 Random LN
Gaylord, MI 49735-9304

Phone

(989) 732-3508

NPI assigned

Aug 29, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Stacey Paul Rogers

Title

Chief Financial Officer

Phone

(502) 429-8062

Specialties & licenses 1

Addresses

Other names 1

• Medilodge of Gaylord Doing business as

Tax ID family

Gaylord Opco LLC2 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.

• Gaylord Opco, LLC

  • Skilled Nursing Facility
  • Gaylord, MI
  • NPI 1215453691
  NPD tax ID

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

{
    "created_epoch": "1503964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503964800000",
    "number": "1154848224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 NEW LA GRANGE RD STE 100",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402224870",
            "telephone_number": "502-429-8062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 RANDOM LN",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497359304",
            "telephone_number": "989-732-3508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAYLORD OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-29",
        "last_updated": "2017-08-29",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "502-429-8062",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medilodge of Gaylord",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Ruth Gawel, RDN, CDCES
• Gaylord Clinical Massage
• Gaylord Eye Care Center Inc
• Gaylord Family Practice Associates PLC
• Gaylord Obstetrics & Gynecology. P.C.
• Gaylord Opco, LLC
• Gaylord Surgery Center, LLC
• Dominic Jerome Giallombardo, MT(ASCP), RN, PA-C
• Brianna Gillen, RRT
• Gilling Chiropractic PC

• Skilled Nursing Facility in Gaylord, MI
• Providers in Gaylord, 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 Aug 29, 2017; 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.