Medilodge of Sterling LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

064010 Issued in MI

Legal business name

MEDILODGE OF STERLING LLC

Practice address

500 S School Rd
Sterling, MI 48659-9799

Phone

(989) 654-2496

NPI assigned

Mar 29, 2006

Organization subpart

No

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

Authorized official

Name

Kathleen Denean

Title

Chief Executive Officer

Phone

(586) 752-5008

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1609837608",
    "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",
            "telephone_number": "586-752-5008",
            "fax_number": "586-752-7609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 S SCHOOL RD",
            "city": "STERLING",
            "state": "MI",
            "postal_code": "486599799",
            "telephone_number": "989-654-2496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDILODGE OF STERLING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "DENEAN",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "586-752-5008"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MI",
            "license": "064010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MICHIGAN",
            "identifier": "S9501",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4151193",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Linda Joy Latulip, MSW
• Joshua Leonard
• Amy Londry
• Timothy Donald Macon, D.O.,F.C.C.P.
• Raelene McKeon Kent, D.O
• Lynn Alene Meyers, FNP
• Morgan Mrozinski
• Hope Murphy, RPH
• James D. O'Brien, D.O.
• Ifeanyi Ojinnaka

• Skilled Nursing Facility in Sterling, MI
• Providers in Sterling, 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 May 1, 2008; 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.