Provider Demographics
NPI:1235465675
Name:BARUCH SLS, INC.
Entity Type:Organization
Organization Name:BARUCH SLS, INC.
Other - Org Name:FOUNTAIN VIEW OF GRANT - LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY / TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-464-1564
Mailing Address - Street 1:50 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327-8426
Mailing Address - Country:US
Mailing Address - Phone:231-834-8202
Mailing Address - Fax:
Practice Address - Street 1:50 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:MI
Practice Address - Zip Code:49327-8426
Practice Address - Country:US
Practice Address - Phone:231-834-8202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARUCH SLS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI23D0975379291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory