- Enrollment id
- O20160310002492
- Enrollment state
- MI
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1053785642
- Multiple npi flag
- N
- Ccn
- 235330
- Associate id
- 4880990282
- Organization name
- HOWELL OPCO LLC
- Doing business as name
- MEDILODGE OF LIVINGSTON
- Incorporation date
- 2013-09-16
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MEDILODGE OF LIVINGSTON
- Affiliation entity name
- MEDILODGE
- Affiliation entity id
- 345
- Address line 1
- 3003 W GRAND RIVER AVE
- City
- HOWELL
- State
- MI
- Zip code
- 488438539