Healthcare Provider Details

I. General information

NPI: 1326013731
Provider Name (Legal Business Name): MEDILODGE OF MONROE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 VILLAGE GREEN LN
MONROE MI
48162-3367
US

IV. Provider business mailing address

481 VILLAGE GREEN LN
MONROE MI
48162-3367
US

V. Phone/Fax

Practice location:
  • Phone: 734-242-6282
  • Fax: 734-242-6491
Mailing address:
  • Phone: 734-242-6282
  • Fax: 734-242-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number584040
License Number StateMI

VIII. Authorized Official

Name: MS. JANET E DALY
Title or Position: NURSING HOME ADMINISTRATOR
Credential: RN,NHA
Phone: 734-242-6282