Provider Demographics
NPI:1760609101
Name:BARUCH SLS, INC.
Entity Type:Organization
Organization Name:BARUCH SLS, INC.
Other - Org Name:CAMBRIDGE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLAUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-285-0573
Mailing Address - Street 1:3075 ORCHARD VISTA DR SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7069
Mailing Address - Country:US
Mailing Address - Phone:616-285-0573
Mailing Address - Fax:616-464-2470
Practice Address - Street 1:151 PORT SHELDON RD SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2149
Practice Address - Country:US
Practice Address - Phone:616-457-6010
Practice Address - Fax:616-457-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI310400000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility