South Haven Opco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SOUTH HAVEN OPCO, LLC

Doing business as

Medilodge of South Haven

Practice address

120 Baseline Rd
South Haven, MI 49090-1037

Phone

(269) 637-8411

NPI assigned

Mar 17, 2021

Organization subpart

No

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

Authorized official

Name

Jonathan Ohlsen, JD

Title

Chief Legal Officer

Phone

(541) 543-1215

Specialties & licenses 1

Addresses

Other names 1

• Medilodge of South Haven Doing business as

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

{
    "created_epoch": "1615939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615939200000",
    "number": "1649855917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 NEW LA GRANGE RD STE 100",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402224870",
            "telephone_number": "502-429-8062",
            "fax_number": "502-429-5980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 BASELINE RD",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490901037",
            "telephone_number": "269-637-8411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH HAVEN OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-17",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A",
        "authorized_official_last_name": "OHLSEN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "CHIEF LEGAL OFFICER",
        "authorized_official_telephone_number": "541-543-1215",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medilodge of South Haven",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Caleb H Springsteen, MD

• Skilled Nursing Facility in South Haven, MI
• Providers in South Haven, 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 Mar 17, 2021; 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.