Dixie Lodge, LLC

NPI #1962916692 in Holly, Michigan

Provider Information

NPI Number: 1962916692
Entity Type: Organization
Organization Name: Dixie Lodge, LLC
Primary Specialty: Residential Treatment Facility, Physical Disabilities
Enumeration Date: Nov 16, 2017
Last Updated: May 22, 2023

Practice Location

Address: 10483 DIXIE HWY
City: Holly
State: Michigan
ZIP Code: 48442-9311
Phone: (810) 866-4277

Authorized Official

Name: MS. MARGARET SHERRY PEMBERTON
Title: VICE PRESIDENT
Phone: (502) 272-3466

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Custodial Care Facility - Adult Care Home — Adult Care Home	311ZA0620X
Residential Treatment Facility, Physical Disabilities	320700000X	Primary

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