Medilodge of Richmond, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

504160 Issued in MI

Legal business name

MEDILODGE OF RICHMOND, INC.

Practice address

34901 Division Rd
Richmond, MI 48062-1559

Phone

(586) 727-7562

NPI assigned

Mar 27, 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 Richmond2 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.

• Richmond Opco LLC

  • Skilled Nursing Facility
  • Richmond, MI
  • NPI 1316388622
  NPD tax ID

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1174583769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "64500 VAN DYKE RD",
            "city": "WASHINGTON",
            "state": "MI",
            "postal_code": "480952583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34901 DIVISION RD",
            "city": "RICHMOND",
            "state": "MI",
            "postal_code": "480621559",
            "telephone_number": "586-727-7562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDILODGE OF RICHMOND, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2008-07-29",
        "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": "504160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MICHIGAN",
            "identifier": "09908",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2152422",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patrick K. McClellan, D.O.
• Cole P McCloskey, DDS
• Katherine Susan McCloskey, 101YA0400X
• Madeleine McConnell, LPC, CAADC, CCS
• Lynnsey McCoy
• Memphis Family Chiropractic PLC
• Heather A Miller, L.P.C., L.B.S.W.
• Alaina Miron, DPT
• Tina L Mizla
• Marissa Molinaro, PT

• Skilled Nursing Facility in Richmond, MI
• Providers in Richmond, 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 29, 2008; 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.