Medilodge of Port Huron, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MEDILODGE OF PORT HURON, LLC

Practice address

5635 Lakeshore Rd
Fort Gratiot, MI 48059-2817

Phone

(810) 385-7447

NPI assigned

Jun 13, 2008

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

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

{
    "created_epoch": "1213315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213315200000",
    "number": "1891955720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5635 LAKESHORE RD",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480592817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5635 LAKESHORE RD",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480592817",
            "telephone_number": "810-385-7447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDILODGE OF PORT HURON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-13",
        "last_updated": "2008-06-13",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jenna McTevia
• Garret McVay
• Aaliyah Bernice Meadows
• Michelle Lee Measel-Morris
• Rebecca Medcraft, MS, OTRL
• Aimee Estelle Meerschaert
• Shahil Yusufali Meghani, PT
• Shilpa Mehta, PT
• Meijer Inc
• Bria Alise Mercurio

• All providers in Fort Gratiot, MI
• Skilled Nursing Facility in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.