Healthcare Provider Details

I. General information

NPI: 1790180255
Provider Name (Legal Business Name): GRAND BLANC OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2014
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11941 BELSAY RD
GRAND BLANC MI
48439-1702
US

IV. Provider business mailing address

7400 NEW LA GRANGE RD STE 400
LOUISVILLE KY
40222-4870
US

V. Phone/Fax

Practice location:
  • Phone: 810-694-1970
  • Fax: 810-694-4081
Mailing address:
  • Phone: 502-429-8062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. STACEY PAUL ROGERS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 502-429-0650