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General NPI Number Information
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NPI Number | 1720248644
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Entity Type | Organization
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Legal Business Name | MEDILODGE OF MILFORD, LLC
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Dates
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Enumeration Date | 06/13/2008
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Last Update Date | 09/04/2013
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Provider Practice Location Address
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Address Line | 555 HIGHLAND AVE
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City | MILFORD
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State | MI
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Zip | 48381-1517
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Country | US
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Telephone | 248-685-1460
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Fax | 248-684-1564
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Provider Business Mailing Address
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Address Line | 555 HIGHLAND AVE
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City | MILFORD
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State | MI
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Zip | 48381-1517
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Country | US
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Telephone | 586-752-5008
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Fax | 586-752-7609
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICIER
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Name | KATHLEEN DENEAN
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Credential |
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Telephone | 586-752-5008
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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 |
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License Number State |
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