Medilodge of Sterling Heights, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

504170 Issued in MI

Legal business name

MEDILODGE OF STERLING HEIGHTS, INC.

Practice address

14151 15 Mile Rd
Sterling Heights, MI 48312-5507

Phone

(586) 939-0200

NPI assigned

Mar 27, 2006

Last updated

Jul 29, 2008By the provider in NPPES

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

Tax ID family

Medilodge of Sterling Heights2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Sterling Heights Opco LLC

  dba Medilodge of Sterling Heights

  • Skilled Nursing Facility
  • Sterling Heights, MI
  • NPI 1174964480
  NPD tax ID

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

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1841250453",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14151 15 MILE RD",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483125507",
            "telephone_number": "586-939-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDILODGE OF STERLING HEIGHTS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2008-07-29",
        "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": "504170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MICHIGAN",
            "identifier": "09549",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3025783",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Medmasters Pharmacy 2 LLC
• Medmasters Pharmacy 3 LLC

• Skilled Nursing Facility in Sterling Heights, MI
• Providers in Sterling Heights, 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 Jul 29, 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.