HAGGERTY ROAD OPCO LLC
NPI 1386432946
Skilled Nursing Facility in Plymouth, MI

Active since April 25, 2025CLIA 23D0680953 · Waiver
105 N HAGGERTY RD, PLYMOUTH, MI 48170(734) 455-0510(734) 455-7359 Get Directions Write a Review

NPPES record last updated: October 23, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Haggerty Road Opco Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HAGGERTY ROAD OPCO LLC (NPI 1386432946), doing business as Medilodge Of Haggerty Road, is a healthcare organization registered as a skilled nursing facility in Plymouth, Michigan and active in the NPI registry since April 2025. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Kristine Ranel Kirk, Delegated Official, as its authorized official.

NPPES Registry Identity

NPI1386432946
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameHAGGERTY ROAD OPCO LLC
Location Address105 N HAGGERTY RDPlymouth, MI 48170-1801
Mailing Address105 N Haggerty RdPlymouth, MI 48170-1801 · (734) 455-0510 · Fax (734) 455-7359
Fax(734) 455-7359
Organization SubpartNo
Authorized OfficialKristine Ranel KirkDelegated Official · (417) 846-3521
Enumeration DateApril 25, 2025
Last NPPES UpdateOctober 23, 2025
NPPES CertifiedOctober 23, 2025
NPI 1386432946 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(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.
105 N HAGGERTY RD, Plymouth, MI 48170

Other Names 1

Doing Business AsMedilodge Of Haggerty Road

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 23D0680953

Haggerty Road Opco, LLC · Plymouth, MI
Active · expires Aug 31, 2026
CLIA Number23D0680953
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorTina Long
Laboratory Phone(734) 455-0510
Laboratory LocationHaggerty Road Opco, LLC105 N Haggerty Rd, Plymouth, MI 48170
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Internal Medicine (Geriatric Medicine)
105 N HAGGERTY RD
PLYMOUTH, MI 48170
Physical Therapist
105 N HAGGERTY RD
PLYMOUTH, MI 48170
Nurse Practitioner (Primary Care)
105 N HAGGERTY RD
PLYMOUTH, MI 48170
Occupational Therapist
105 N HAGGERTY RD
PLYMOUTH, MI 48170
Skilled Nursing Facility
105 N HAGGERTY RD
PLYMOUTH, MI 48170
Social Worker
105 N HAGGERTY RD
PLYMOUTH, MI 48170
Skilled Nursing Facility
105 N HAGGERTY RD
PLYMOUTH, MI 48170
Physical Therapist
105 N HAGGERTY RD
PLYMOUTH, MI 48170

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Haggerty Road Opco LLC's NPI number?

The NPI number for Haggerty Road Opco LLC is 1386432946. It was assigned to this organization in the NPPES registry on April 25, 2025. The provider is doing business as Medilodge of Haggerty Road.

Where is Haggerty Road Opco LLC located?

Haggerty Road Opco LLC is located at 105 N Haggerty Rd, Plymouth, MI 48170. The listed phone number is (734) 455-0510.

What is Haggerty Road Opco LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Haggerty Road Opco LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 23D0680953) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Haggerty Road Opco LLC was last updated on October 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.