Munising Opco, LLC
Organization Active NPI Skilled Nursing Facility · Munising, MI
NPI 1497271795 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1497271795
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- MUNISING OPCO, LLC
- Practice address
- 300 City Park Dr
Munising, MI 49862-1130 - Phone
- (906) 387-2273
- NPI assigned
- Aug 17, 2017
- 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 2
Affiliated clinicians 3
-
Mark D Cecilio, MD
Medicare Care Compare: Nursing home
- Listed as
- Medilodge of Munising
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Nov 1, 1980
- Medicare certification status
- Active
- Certified beds
- 90 · 73.2 residents per day on average
- Chain
- Medilodge
- Penalties (3 years)
- 2 · fines totaling $84,659
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0382261 | Munising Opco, LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Skilled nursing facility certification: CCN 235410
- Legal name
- MUNISING OPCO LLC
- Doing business as
- MEDILODGE OF MUNISING
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Nov 1, 1980
- Last certification
- Oct 24, 2024
- Beds
- 90
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Prestige Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 25, 2017 in DE
- Enrollment address
- 300 City Park Dr
Munising, MI 49862-1130 - Nursing home name
- MEDILODGE OF MUNISING
- Affiliated entity
- MEDILODGE
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Cody Healthcare S Corp |
5% Or Greater Indirect Ownership Interest | Feb 1, 2018 | 47.55% |
| B&Y Trust |
5% Or Greater Indirect Ownership Interest | Feb 1, 2018 | 47.55% |
| Prestige Administrative Services, LLC |
Operational/Managerial Control | Feb 1, 2018 | |
| Blossom Healthcare Management LLC |
Operational/Managerial Control | Feb 1, 2018 | |
| Craig a Flashner |
Corporate Director |
Feb 1, 2018 | |
| Operational/Managerial Control |
Feb 1, 2018 | ||
| Kristine Ranel Kirk |
W-2 Managing Employee |
Feb 1, 2018 | |
| Robert L Norcross |
Contracted Managing Employee |
Feb 1, 2018 | |
| Craig Flashner 2007 Trust |
5% Or Greater Indirect Ownership Interest | Feb 1, 2018 | 47.55% |
| B&Y Healthcare S Corp |
5% Or Greater Indirect Ownership Interest | Feb 1, 2018 | 47.55% |
| Stacey Paul Rogers |
Contracted Managing Employee |
Feb 1, 2018 | |
| Yitzchok a Perlstein |
Corporate Director |
Feb 1, 2018 | |
| Operational/Managerial Control |
Feb 1, 2018 | ||
| Everest Opco Group LLC |
5% Or Greater Direct Ownership Interest | Feb 1, 2018 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180213002136 | MI | Part a Provider - Skilled Nursing Facility | 5698035608 | Practice locations: Munising, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
300 City Park Dr
Munising, MI 49862-1130
Mailing address
7400 New la Grange Rd Ste 100
Louisville, KY 40222-4870
Phone (502) 429-8062
Other practice location 1
300 City Park Dr
Munising, MI 49862-1130
Other names
- Medilodge of Munising
Other providers in Munising, MI
- Munising Memorial Hospital Association
- Munising Memorial Hospital Association
- Munising Memorial Hospital Association
- Munising Memorial Hospital Association
- Munising Memorial Hospital Association
- Renae Nelson
- Mercy Adeola Odueyungbo
- Kurt Richard Olson
- Mark Walter Olson
- Ryan Kurt Olson
All providers in Munising, 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 Jul 21, 2022. 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.