Medilodge of Royal Oak

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

634360 Issued in MI

Legal business name

MEDILODGE OF ROYAL OAK

Practice address

3030 Greenfield Rd
Royal Oak, MI 48073-6528

Phone

(248) 288-6610

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

Jan Kueppers

Title

Chief Financial Officer

Phone

(586) 752-5008

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396705992",
    "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": "3030 GREENFIELD RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736528",
            "telephone_number": "248-288-6610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDILODGE OF ROYAL OAK",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KUEPPERS",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "586-752-5008"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "634360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MICHIGAN",
            "identifier": "09982",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2695973",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Royal Oak, MI
• Providers in Royal Oak, 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 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.