Organization Active NPI

Kalamazoo Opco, LLC

Doing business as Medilodge of Kalamazoo

Skilled Nursing Facility
Kalamazoo, MI

National Provider Identifier

1578960795

Registry record updated Jul 16, 2015

On this page

Key facts
NPPES NPI Registry
Medicare participation
Care Compare: Nursing home
Laboratory certificates & supplier records
National Provider Directory
Ownership & related parties
Practitioners & affiliated clinicians
NPI Registry JSON
Other providers in Kalamazoo, MI
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name: KALAMAZOO OPCO, LLC
Doing business as: Medilodge of Kalamazoo
Practice address: 1701 S 11TH St
Kalamazoo, MI 49009-1775
Phone: (269) 375-2020
Fax: (269) 375-7990
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)	Code	License	State	Primary
Skilled Nursing Facility	314000000X			Primary

Addresses

Primary practice location

1701 S 11TH St
Kalamazoo, MI 49009-1775

Mailing address

7400 New la Grange Rd
Suite 100
Louisville, KY 40222-4870
Phone (502) 429-8062

Other identifiers 1

Identifier	Type	State	Issuer
1578960795	Medicaid	MI

Other names 1

Medilodge of Kalamazoo Doing business as

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Enrolled in MI

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
O20150930001754	MI	Part A Provider - Skilled Nursing Facility	7214245968	Practice locations: Kalamazoo, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578960795. Details of each certification follow.

CCN 235282 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 235282

Legal name: KALAMAZOO OPCO, LLC
Doing business as: MEDILODGE OF KALAMAZOO
Certification status: Active
Provider type (POS): Nursing home – SNF/NF dual certification
Participating since: Apr 5, 1976
Last certification: Aug 1, 2024
Beds: 39
Ownership / control type: Limited Liability Corporation
Organization structure: LLCProprietary
Incorporated: Nov 14, 2014 in DE
Enrollment address: 1701 S 11TH St
Kalamazoo, MI 49009-1775
Nursing home name: MEDILODGE OF KALAMAZOO
Affiliated entity: MEDILODGE

Care Compare: Nursing home

Medicare Care Compare

Listed as: Medilodge of KalamazooCCN 235282 · All quality measures
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 - Limited Liability company
Certified: Apr 5, 1976
Medicare certification status: ActiveFrom the Provider of Services file
Certified beds: 3937.1 residents per day on average
Chain: Medilodge53 facilities in the chain
Penalties (3 years): 1Fines totaling $0

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 number	Laboratory	Certificate	Expires
23D0669237	Kalamazoo Opco, LLC1701 S 11TH Street, Kalamazoo, MI 49009	Certificate of waiver	Aug 31, 2026

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

Name	Role	Since	Share
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
Craig a Flashner Individual	Operational/Managerial ControlLLC Member / Governing Body	Jul 1, 2015
Kristine Ranel Kirk Individual	W-2 Managing EmployeeBusiness Manager	Sep 2, 2016
Robert L Norcross Individual	Contracted Managing EmployeeCeo	Jul 1, 2015
Craig Flashner 2007 Trust Organization, Agoura Hills, CA	5% Or Greater Indirect Ownership Interest	Jul 1, 2015	47.55%
Stacey Paul Rogers Individual	Operational/Managerial ControlCfo	Jul 1, 2015
Noble Healthcare Management, LLC Organization, Washington, MI LLC, Management services company, For-profit	Operational/Managerial Control	Jul 1, 2015
Yitzchok a Perlstein Individual	Corporate DirectorLLC Member	Jul 2, 2015
Yitzchok a Perlstein Individual	Operational/Managerial ControlLLC Member / Governing Body	Jul 1, 2015

Facilities with the same owner 77

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

Alpena Opco LLC

dba Medilodge of Alpena
- Skilled Nursing Facility
- Alpena, MI
- NPI 1891211264
B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC
CMS ownership
Capital Area Opco LLC

dba Medilodge of Capital Area
- Skilled Nursing Facility
- Lansing, MI
- NPI 1528465739
Ark Opco Group, LLC, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Noble Healthcare Management, LLC, Prestige Administrative Services, LLC
CMS ownership
Cass City Opco LLC

dba Medilodge of Cass City
- Skilled Nursing Facility
- Cass City, MI
- NPI 1316344526
Ark Opco Group, LLC, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC
CMS ownership
Cheboygan Opco LLC

dba Medilodge of Cheboygan
- Skilled Nursing Facility
- Cheboygan, MI
- NPI 1295251676
B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC
CMS ownership
Clare Opco LLC

dba Medilodge of Clare
- Skilled Nursing Facility
- Clare, MI
- NPI 1659778868
Ark Opco Group, LLC, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Noble Healthcare Management, LLC, Prestige Administrative Services, LLC
CMS ownership
East Lansing Opco LLC

dba Medilodge of Campus Area
- Skilled Nursing Facility
- East Lansing, MI
- NPI 1730546250
B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC
CMS ownership
Farmington Opco LLC

dba Medilodge of Farmington
- Skilled Nursing Facility
- Farmington, MI
- NPI 1629442215
B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust
CMS ownership
Frankenmuth Opco, LLC

dba Medilodge of Frankenmuth
- Skilled Nursing Facility
- Frankenmuth, MI
- NPI 1427455641
Ark Opco Group, LLC, B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Noble Healthcare Management, LLC, Prestige Administrative Services, LLC
CMS ownership
Gaylord Opco, LLC

dba Medilodge of Gaylord
- Skilled Nursing Facility
- Gaylord, MI
- NPI 1215453691
B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC
CMS ownership
Grand Blanc Opco LLC

dba Medilodge of Grand Blanc
- Skilled Nursing Facility
- Grand Blanc, MI
- NPI 1790180255
B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC
CMS ownership
Grand Haven Opco LLC

dba Medilodge at the Shore
- Skilled Nursing Facility
- Grand Haven, MI
- NPI 1770078263
B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC
CMS ownership
Grand Rapids Opco, LLC

dba Medilodge of Grand Rapids
- Skilled Nursing Facility
- Grand Rapids, MI
- NPI 1083347660
B&Y Trust, Cody Healthcare S Corp, Craig Flashner 2007 Trust, Prestige Administrative Services, LLC
CMS ownership

View all 77

Practitioners & affiliated clinicians

Practitioners 2

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.

Nicoara Oprescu
- Internal Medicine Physician
- Kalamazoo, MI
- NPI 1225146533
NPD (past)
Mailvaganam Sridharan, M.D.
- Internal Medicine Physician
- Kalamazoo, MI
- NPI 1598714990
NPD (past)

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Nicoara Oprescu
- Internal Medicine Physician
- Kalamazoo, MI
- NPI 1225146533
Nursing home
Care Compare affiliation
Mailvaganam Sridharan, M.D.
- Internal Medicine Physician
- Kalamazoo, MI
- NPI 1598714990
Nursing home
Care Compare affiliation

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": "1578960795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 NEW LA GRANGE RD",
            "address_2": "SUITE 100",
            "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": "1701 S 11TH ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490091775",
            "telephone_number": "269-375-2020",
            "fax_number": "269-375-7990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALAMAZOO 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": "1578960795",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medilodge of Kalamazoo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kalamazoo, MI

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.