Medilodge of Port Huron
5635 Lakeshore, Fort Gratiot, MI 48059


Medilodge of Port Huron is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 235421. The address is 5635 Lakeshore, Fort Gratiot, MI 48059. The zip code is 48059. The phone number is 8103857447.


Medilodge of Port Huron · 5635 Lakeshore, Fort Gratiot, MI 48059

Federal Provider Number 235421
Provider Name MEDILODGE OF PORT HURON
Address 5635 LAKESHORE
FORT GRATIOT, MI 48059
Phone Number 8103857447
SSA County Code 730
County Name St. Clair
Ownership Type For profit - Individual
Certified Beds 127
Certified Beds Residents 108
Provider Type Medicare and Medicaid
Resides in Hospital false
Legal Business Name PORT HURON OPCO LLC
Date First Approved to Provide Medicare Medicaid Services 02/12/1982
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 5
Health Inspection Rating 4
Quality Measure Rating 5
Staffing Rating 3
RN Staffing Rating 3
Reported CNA Staffing Hours per Resident per Day 2.0625
Reported LPN Staffing Hours per Resident per Day 0.94352
Reported RN Staffing Hours per Resident per Day 0.69028
Reported Licensed Staffing Hours per Resident per Day 1.6338
Reported Total Nurse Staffing Hours per Resident per Day 3.6963
Reported Physical Therapist Staffing Hours per Resident Per Day 0.04444
Expected CNA Staffing Hours per Resident per Day 2.40891
Expected LPN Staffing Hours per Resident per Day 0.69647
Expected RN Staffing Hours per Resident per Day 1.10132
Expected Total Nurse Staffing Hours per Resident per Day 4.2067
Adjusted CNA Staffing Hours per Resident per Day 2.10085
Adjusted LPN Staffing Hours per Resident per Day 1.12441
Adjusted RN Staffing Hours per Resident per Day 0.46833
Adjusted Total Nurse Staffing Hours per Resident per Day 3.54183
Cycle 1 Total Number of Health Deficiencies 7
Cycle 1 Number of Standard Health Deficiencies 4
Cycle 1 Number of Complaint Health Deficiencies 3
Cycle 1 Health Deficiency Score 48
Cycle 1 Standard Survey Health Date 01/11/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 48
Cycle 2 Total Number of Health Deficiencies 6
Cycle 2 Number of Standard Health Deficiencies 2
Cycle 2 Number of Complaint Health Deficiencies 4
Cycle 2 Health Deficiency Score 40
Cycle 2 Standard Health Survey Date 12/02/2015
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 40
Cycle 3 Total Number of Health Deficiencies 9
Cycle 3 Number of Standard Health Deficiencies 8
Cycle 3 Number of Complaint Health Deficiencies 1
Cycle 3 Health Deficiency Score 44
Cycle 3 Standard Health Survey Date 01/16/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 44
Total Weighted Health Survey Score 44.667
Number of Facility Reported Incidents 2
Number of Substantiated Complaints 5
Number of Fines 1
Total Amount of Fines in Dollars $13571.00
Total Number of Penalties 1
Processing Date 08/01/2017

Owner or Manager · Medilodge of Port Huron

Owner Name Role Association Date
B&Y HEALTHCARE S CORP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/24/2013
B&Y TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/24/2013
BROOKS, CARLA (Individual) MANAGING EMPLOYEE since 06/24/2013
CODY HEALTHCARE S CORP (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/24/2013
CRAIG FLASHNER 2007 TRUST (Organization) 5% OR GREATER INDIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 06/24/2013
FALK, JERI (Individual) MANAGING EMPLOYEE since 11/01/2013
FIFTEENINONE OPCO GROUP LLC (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
100%
since 06/24/2013
FLASHNER, CRAIG (Individual) OPERATIONAL/MANAGERIAL CONTROL since 06/24/2013
GENERATIONS HEALTHCARE MANAGEMENT LLC (Organization) OPERATIONAL/MANAGERIAL CONTROL since 06/24/2013
NORCROSS, ROBERT (Individual) MANAGING EMPLOYEE since 06/24/2013
PERLSTEIN, YITZCHOK (Individual) OPERATIONAL/MANAGERIAL CONTROL since 06/24/2013

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