Organization Active NPI

Holland Opco, LLC

Doing business as Medilodge of Holland

  • Skilled Nursing Facility
  • Holland, MI
National Provider Identifier
1225435449
Registry record updated Jul 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
HOLLAND OPCO, LLC
Doing business as
Medilodge of Holland
Practice address
1221 E 16TH St
Holland, MI 49423-9127
Phone
(616) 396-7095
Fax
(616) 396-7157
NPI assigned
Dec 3, 2014
Last updated
Jul 16, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2015

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

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1221 E 16TH St
Holland, MI 49423-9127

Mailing address

7400 New la Grange Rd
Louisville, KY 40222-4870
Phone (502) 429-8062

Other identifiers 1

IdentifierTypeStateIssuer
1225435449MedicaidMI

Other names 1

  • Medilodge of Holland Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151112000147 MI Part A Provider - Skilled Nursing Facility 6406161017 Practice locations: Holland, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225435449. Details of each certification follow.

Skilled nursing facility certification: CCN 235638

Legal name
HOLLAND OPCO LLC
Doing business as
MEDILODGE OF HOLLAND
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Mar 7, 2008
Last certification
May 8, 2025
Beds
77
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Jul 1, 2015
Organization structure
LLCProprietary
Incorporated
Nov 14, 2014 in DE
Enrollment address
1221E 16TH St
Holland, MI 49423-9127
Nursing home name
MEDILODGE OF HOLLAND
Affiliated entity
MEDILODGE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Medilodge of HollandCCN 235638 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Mar 7, 2008
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7773.6 residents per day on average
Chain
Medilodge53 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1073038Holland Opco, LLC1221 E 16TH Street, Holland, MI 49423Certificate of waiverAug 28, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ark Opco Group, LLC Organization, Louisville, KY LLC, For-profit 5% Or Greater Direct Ownership Interest Jul 1, 2015 100%
Cody Healthcare S Corp Organization, Agoura Hills, CA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2015 47.55%
B&Y Trust Organization, Brooklyn, NY 5% Or Greater Indirect Ownership Interest Jul 1, 2015 47.55%
Prestige Administrative Services, LLC Organization, Louisville, KY LLC, Consulting firm, For-profit Operational/Managerial Control Jan 1, 2016
Craig a Flashner Individual Corporate DirectorLLC Member Jul 2, 2015
Operational/Managerial ControlLLC Member / Governing Body Jul 2, 2015
Kristine Ranel Kirk Individual W-2 Managing EmployeeBusiness Manager Sep 2, 2016
Robert L Norcross Individual Contracted Managing EmployeeChief Executive Officer Jul 1, 2015
Craig Flashner 2007 Trust Organization, Agoura Hills, CA 5% Or Greater Indirect Ownership Interest Jul 1, 2015 47.55%
B&Y Healthcare S Corp Organization, Brooklyn, NY Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jul 1, 2015 47.55%
Stacey Paul Rogers Individual Contracted Managing EmployeeCfo Jul 1, 2015
Noble Healthcare Management, LLC Organization, Louisville, KY LLC, Management services company, For-profit Operational/Managerial Control Jul 1, 2015
Yitzchok a Perlstein Individual Corporate DirectorLLC Member Jul 2, 2015
Operational/Managerial ControlLLC Member / Governing Body Jul 2, 2015

Facilities with the same owner 77

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 77

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437004800000",
    "number": "1225435449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 NEW LA GRANGE RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402224870",
            "telephone_number": "502-429-8062",
            "fax_number": "502-429-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 E 16TH ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494239127",
            "telephone_number": "616-396-7095",
            "fax_number": "616-396-7157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLAND OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-03",
        "last_updated": "2015-07-16",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225435449",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medilodge of Holland",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holland, MI

Sources for this page

Verify at the official NPI Registry.