WYOMING OPCO, LLC (NPI# 1831596907) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831596907 |
| Entity Type | Organization |
| Organization Name | WYOMING OPCO, LLC |
| Other Organization Name | MEDILODGE OF WYOMING |
| Practice Address |
2786 56th St Sw Wyoming MI 49418-8708 |
| Mailing Address |
7400 New La Grange Rd Suite 100 Louisville KY 40222-4870 |
| Practice Telephone | 6162613960 |
| Practice Fax Number | 6162613925 |
| Mailing Telephone | 5024298062 |
| Mailing Fax Number | 5024290650 |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2015-07-17 |
| Authorized Official Name | MR. STACEY PAUL ROGERS (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 5024298062 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1831596907 | 05 |
| Other Name | Type Code |
|---|---|
| Medilodge of Wyoming | Doing Business As Name - Organization |
| Street Address |
2786 56TH ST SW |
| City | WYOMING |
| State | MI |
| Zip Code | 49418-8708 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568591733 | Tendercare Michigan Inc. | Skilled Nursing Facility | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2007-03-05 |
| 1982165387 | Rachel Mervau | Occupational Therapist | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2019-03-28 |
| 1891207080 | Marissa Lauren Bergsma | Speech-Language Pathologist | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2017-10-29 |
| 1265982185 | Kella Rose Wills | Occupational Therapist | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2016-10-04 |
| 1831647684 | Adislen Costa | Physical Therapist | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2016-09-21 |
| 1619424579 | Emily Byl | Occupational Therapist | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2016-09-07 |
| 1740658764 | Christian Winther IIi | Occupational Therapist | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2015-09-08 |
| 1366839615 | Kristina Willyard | Physical Therapist | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2015-04-23 |
| 1114314507 | Darcie Lynne Owen | Physical Therapy Assistant | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2015-04-23 |
| 1447647722 | Shelby Heyboer | Health Maintenance Organization | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2015-04-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144799669 | Holly Cieslinski | Occupational Therapist | 3550 Fairlines Ave, Grandville, MI 49418 | 2018-11-14 |
| 1639664857 | Athletico Ltd | Physical Therapist | 3819 Rivertown Pkwy Sw Ste 100, Grandville, MI 49418 | 2018-06-29 |
| 1437651916 | Great Lakes Wellness Counseling LLC | Counselor | 2900 Wilson Ave Suite 110, Grandville, MI 49418 | 2018-03-01 |
| 1780111765 | Jenna Sargent | Nurse Practitioner | 2845 44th St Sw, Ste 200, Grandville, MI 49418 | 2017-05-22 |
| 1881132827 | Laura Elizabeth Ramaker | Specialist/Technologist | 2787 Pine Dunes Ct Sw, Wyoming, MI 49418 | 2017-02-10 |
| 1689026130 | Charles Unseld | Hearing Instrument Specialist | O-38 44th St Sw, Grandville, MI 49418 | 2016-07-08 |
| 1972989655 | Laci Dawn Johncock | Physical Therapy Assistant | 2786 56th Street, Wyoming, MI 49418 | 2015-08-05 |
| 1891178570 | Joshua Kolman | Pharmacist | 3434 Century Center Dr Sw, Grandville, MI 49418 | 2015-06-30 |
| 1710368782 | Tracie Medrano- Smith | Family Medicine | 4174 56th St Sw, Wyoming, MI 49418 | 2015-06-15 |
| 1124410808 | Kim Michelle Childress | Counselor | 4565 Wilson Ave Sw Ste 3a, Grandville, MI 49418 | 2015-03-04 |
| Find all providers in zip 49418 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326565862 | Healthbridge LLC | Skilled Nursing Facility | 2060 Health Dr Sw, Wyoming, MI 49519-9687 | 2017-08-25 |
| 1568591733 | Tendercare Michigan Inc. | Skilled Nursing Facility | 2786 56th St Sw, Wyoming, MI 49418-8708 | 2007-03-05 |
| 1376582254 | Heartland - Crestview Mi LLC | Skilled Nursing Facility | 625 36th St Sw, Wyoming, MI 49509-4004 | 2006-06-06 |
| 1073002606 | Crestview Snf, LLC | Skilled Nursing Facility | 625 36th St Sw, Wyoming, MI 49509 | 2018-05-09 |
| 1679916571 | Ebenezer Lakes Assisted Living | Skilled Nursing Facility | 25565 Fairview Ave, Wyoming, MN 55092-8053 | 2013-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538798731 | Windemere Park of Troy Operations LLC | Skilled Nursing Facility | 5990 N Adams Rd, Troy, MI 48098-2377 | 2020-04-08 |
| 1982235396 | Berg-lahser Snf, LLC | Skilled Nursing Facility | 21630 Hessel Ave # 1230, Detroit, MI 48219-1230 | 2020-02-04 |
| 1508497918 | Harmony Village Snf, LLC | Skilled Nursing Facility | 16588 Schaefer Hwy # 4249, Detroit, MI 48235-4249 | 2020-02-04 |
| 1336795244 | Ishpeming Nursing & Rehab Center, LLC | Skilled Nursing Facility | 435 Rd Pl, Ishpeming, MI 49849 | 2019-08-15 |
| 1669965299 | Wellbridge of Clarkston, LLC | Skilled Nursing Facility | 5655 Clarkston Road, Independence Township, MI 48348 | 2018-06-08 |
| 1104318112 | Wellbridge At Genesys Health Park, LLC | Skilled Nursing Facility | 3139 East Baldwin Road, Grand Blanc, MI 48439 | 2018-06-05 |
| 1427549955 | Mission Point of Detroit, LLC | Skilled Nursing Facility | 2102 Orleans, Detroit, MI 48207 | 2018-05-21 |
| 1912496324 | Regency At Independence Township, LLC | Skilled Nursing Facility | 6211 Stonewood Drive, Clarkston, MI 48346 | 2018-05-02 |
| 1972092344 | Regency At Grand Haven, LLC | Skilled Nursing Facility | 17049 Comstock St, Grand Haven, MI 49417-7903 | 2018-05-01 |
| 1093214173 | Sana Nasir Inc. | Skilled Nursing Facility | 13840 King Rd, Riverview, MI 48193 | 2018-02-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.