- Enrollment id
- O20160405002183
- Enrollment state
- MI
- Provider type code
- 00-18
- Provider type text
- PART A PROVIDER - SKILLED NURSING FACILITY
- Npi
- 1629442215
- Multiple npi flag
- N
- Ccn
- 235293
- Associate id
- 4082912183
- Organization name
- FARMINGTON OPCO LLC
- Doing business as name
- MEDILODGE OF FARMINGTON
- Incorporation date
- 2015-10-05
- Incorporation state
- DE
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Nursing home provider name
- MEDILODGE OF FARMINGTON
- Affiliation entity name
- MEDILODGE
- Affiliation entity id
- 345
- Address line 1
- 34225 GRAND RIVER AVE
- City
- FARMINGTON
- State
- MI
- Zip code
- 483353440