St Clair Opco LLC
Organization Active NPI Skilled Nursing Facility · East China, MI
NPI 1497196703 · NPPES record last updated Dec 30, 2014
Key facts
- NPI
- 1497196703
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- ST CLAIR OPCO LLC
- Practice address
- 4220 Hospital Dr
East China, MI 48054-2200 - Phone
- (810) 329-4736
- Fax
- (810) 329-6282
- NPI assigned
- Jul 15, 2013
- Organization subpart
- No
Authorized official
- Name
- Mr. Stacey Paul Rogers
- Title
- Chief Financial Officer
- Phone
- (502) 429-8062
Facilities with the same owner 77
Practitioners 3
-
Christina Louise Blevins, D.O.
-
Annette Carron, DO
-
Samuel E Ross, M.D.
Affiliated clinicians 2
-
Annette Carron, DO
-
Samuel E Ross, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Medilodge of St. Clair
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Nov 1, 1978
- Medicare certification status
- Active
- Certified beds
- 158 · 117.3 residents per day on average
- Chain
- Medilodge
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0678452 | St Clair Opco, LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Skilled nursing facility certification: CCN 235370
- Legal name
- ST. CLAIR OPCO, LLC
- Doing business as
- MEDILODGE OF ST. CLAIR
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Nov 1, 1978
- Last certification
- Oct 3, 2024
- Beds
- 158
- Ownership / control type
- Corporation
- Multi-facility organization
- Prestige Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 12, 2013 in DE
- Enrollment address
- 4220 Hospital Dr
East China, MI 48054-2200 - Nursing home name
- MEDILODGE OF ST. CLAIR
- Affiliated entity
- MEDILODGE
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Fifteeninone Opco Group LLC |
5% Or Greater Direct Ownership Interest | Jun 24, 2013 | 100% |
| Cody Healthcare S Corp |
5% Or Greater Indirect Ownership Interest | Jun 24, 2013 | 47.55% |
| B&Y Trust |
5% Or Greater Indirect Ownership Interest | Jun 24, 2013 | 47.55% |
| Prestige Administrative Services, LLC |
Operational/Managerial Control | Jan 1, 2016 | |
| Craig a Flashner |
Corporate Director |
Jun 24, 2013 | |
| Operational/Managerial Control |
Jun 24, 2013 | ||
| Kristine Ranel Kirk |
W-2 Managing Employee |
Jan 1, 2018 | |
| Robert L Norcross |
Contracted Managing Employee |
Jun 24, 2013 | |
| Craig Flashner 2007 Trust |
5% Or Greater Indirect Ownership Interest | Jun 24, 2013 | 47.55% |
| B&Y Healthcare S Corp |
5% Or Greater Indirect Ownership Interest | Jun 24, 2013 | 47.55% |
| Generations Healthcare Management LLC |
Operational/Managerial Control | Jun 24, 2013 | |
| Stacey Paul Rogers |
Contracted Managing Employee |
Oct 20, 2014 | |
| Yitzchok a Perlstein |
Corporate Director |
Jun 24, 2013 | |
| Operational/Managerial Control |
Jun 24, 2013 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130815000836 | MI | Part a Provider - Skilled Nursing Facility | 8022250307 | Practice locations: East China, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
4220 Hospital Dr
East China, MI 48054-2200
Mailing address
7400 New la Grange Rd
Suite 100
Louisville, KY 40222-4870
Phone (502) 429-8062
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497196703 | Medicaid | MI |
Other names
- MEDILODGE OF ST CLAIR
Other providers in East China, MI
- Vanessa Schiffelbine
- Jessica Scholey
- Kurt Schultz
- Maryann Selman
- Shannon Showers
- St. Clair Infectious Diseases PC
- Ashley Stacy
- Michael Casey Stewart
- Ashleigh Marie Stier
- Muthiah Subramanian
All providers in East China, MI · Skilled Nursing Facility in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 30, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.