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General NPI Number Information
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NPI Number | 1326013731
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Entity Type | Organization
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Legal Business Name | MEDILODGE OF MONROE, LLC
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Dates
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Enumeration Date | 02/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 481 VILLAGE GREEN LN
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City | MONROE
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State | MI
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Zip | 48162-3367
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Country | US
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Telephone | 734-242-6282
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Fax | 734-242-6491
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Provider Business Mailing Address
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Address Line | 481 VILLAGE GREEN LN
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City | MONROE
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State | MI
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Zip | 48162-3367
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Country | US
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Telephone | 734-242-6282
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Fax | 734-242-6491
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Authorized Official
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Title or Position | NURSING HOME ADMINISTRATOR
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Name | MS. JANET E DALY
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Credential | RN,NHA
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Telephone | 734-242-6282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 584040
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License Number State | MI
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