Provider Demographics
NPI:1811259732
Name:TRILOGY HEALTHCARE OF GENESEE, LLC
Entity type:Organization
Organization Name:TRILOGY HEALTHCARE OF GENESEE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEVYAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-213-1710
Mailing Address - Street 1:5370 E. BALDWIN ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9532
Mailing Address - Country:US
Mailing Address - Phone:810-606-9950
Mailing Address - Fax:810-606-9951
Practice Address - Street 1:5370 E. BALDWIN ROAD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-9532
Practice Address - Country:US
Practice Address - Phone:810-606-9950
Practice Address - Fax:810-606-9951
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRILOGY FSC INVESTORS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-15
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
235660Medicare Oscar/Certification