Grand Haven Opco LLC
Organization Active NPI Skilled Nursing Facility · Grand Haven, MI
NPI 1770078263 · NPPES record last updated May 28, 2026
Key facts
- NPI
- 1770078263
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- GRAND HAVEN OPCO LLC
- Practice address
- 900 S Beacon Blvd
Grand Haven, MI 49417 - Phone
- (616) 846-1850
- NPI assigned
- Jun 27, 2018
- Organization subpart
- No
Authorized official
- Name
- Kristine Ranel Kirk
- Title
- Delegated Official
- Phone
- (417) 846-3521
Facilities with the same owner 77
Practitioners 7
-
Frederick L Bean, M.D.
-
Robert Kenneth Brummeler, M.D.
-
Robert N Israel, M.D.
-
Raymond P Rabideau, D.O.
-
Ronald E Seagle, M.D.
Affiliated clinicians 5
-
Robert Kenneth Brummeler, M.D.
-
Robert N Israel, M.D.
-
Ronald E Seagle, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Medilodge at the Shore
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jan 1, 1980
- Medicare certification status
- Active
- Certified beds
- 126 · 112.9 residents per day on average
- Chain
- Medilodge
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0379293 | Grand Haven Opco, LLC | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Skilled nursing facility certification: CCN 235356
- Legal name
- GRAND HAVEN OPCO, LLC
- Doing business as
- MEDILODGE AT THE SHORE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1980
- Last certification
- Sep 18, 2024
- Beds
- 126
- Ownership / control type
- Corporation
- Multi-facility organization
- Prestige/Medilodge Healthcare
- Organization structure
- LLC · Proprietary
- Incorporated
- Jul 10, 2018 in DE
- Enrollment address
- 900 S Beacon Blvd
Grand Haven, MI 49417-2146 - Nursing home name
- MEDILODGE AT THE SHORE
- Affiliated entity
- MEDILODGE
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Cody Healthcare S Corp |
5% Or Greater Direct Ownership Interest | Sep 1, 2018 | 46.05% |
| B&Y Trust |
5% Or Greater Indirect Ownership Interest | Sep 1, 2018 | 46.05% |
| Prestige Administrative Services, LLC |
Operational/Managerial Control | Sep 1, 2018 | |
| Craig a Flashner |
Operational/Managerial Control |
Sep 1, 2018 | |
| Kristine Ranel Kirk |
W-2 Managing Employee |
Sep 1, 2018 | |
| Robert L Norcross |
Contracted Managing Employee |
Sep 1, 2018 | |
| Craig Flashner 2007 Trust |
5% Or Greater Indirect Ownership Interest | Sep 1, 2018 | 46.05% |
| B&Y Healthcare S Corp |
5% Or Greater Direct Ownership Interest | Sep 1, 2018 | 46.05% |
| Stacey Paul Rogers |
Contracted Managing Employee |
Sep 1, 2018 | |
| Yitzchok a Perlstein |
Operational/Managerial Control |
Sep 1, 2018 | |
| Century Healthcare Management LLC |
Operational/Managerial Control | Sep 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180820000499 | MI | Part a Provider - Skilled Nursing Facility | 8729337167 | Practice locations: Grand Haven, MI |
National Provider Directory
Locations
7400 New La Grange Rd
Ste 400
Louisville, KY 40222
900 S Beacon Blvd
Grand Haven, MI 49417
Phone (616) 296-7300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
900 S Beacon Blvd
Grand Haven, MI 49417
Mailing address
7400 New la Grange Rd Ste 400
Louisville, KY 40222-4870
Phone (502) 429-8062
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770078263 | Medicaid | MI |
Other names
- Medilodge at the Shore
Other providers in Grand Haven, MI
- Autumn Gorman
- Austin Graham
- Grand Haven Bone & Joint, P.C.
- Grand Haven Counseling LLC
- Grand Haven Eyecare, PLLC
- Grand Haven Pathology, PC
- Grand Haven Smiles PLC
- Grand Haven Speech Partners, LLC
- Grand Pines Assisted Living Center
- Emily Gray
All providers in Grand Haven, 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 May 28, 2026. 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.