- Enrollment id
- O20160616000564
- Enrollment state
- MI
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1033576558
- Multiple npi flag
- N
- Ccn
- 235283
- Associate id
- 7012208390
- Organization name
- NORTH LANSING OPCO LLC
- Doing business as name
- MEDILODGE OF EAST LANSING
- Incorporation date
- 2015-12-04
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MEDILODGE OF EAST LANSING
- Affiliation entity name
- MEDILODGE
- Affiliation entity id
- 345
- Address line 1
- 1843 N HAGADORN RD
- City
- EAST LANSING
- State
- MI
- Zip code
- 488232229