Medilodge of Monroe, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

584040 Issued in MI

Legal business name

MEDILODGE OF MONROE, LLC

Practice address

481 Village Green LN
Monroe, MI 48162-3367

Phone

(734) 242-6282

Fax

(734) 242-6491

NPI assigned

Feb 20, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Janet E Daly, RN,NHA

Title

Nursing Home Administrator

Phone

(734) 242-6282

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1140393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326013731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "481 VILLAGE GREEN LN",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623367",
            "telephone_number": "734-242-6282",
            "fax_number": "734-242-6491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 VILLAGE GREEN LN",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623367",
            "telephone_number": "734-242-6282",
            "fax_number": "734-242-6491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDILODGE OF MONROE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DALY",
        "authorized_official_first_name": "JANET",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "NURSING HOME ADMINISTRATOR",
        "authorized_official_telephone_number": "734-242-6282",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN,NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "584040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4216270",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.