Provider Demographics
NPI:1922004548
Name:THE CONTINUUM OF CLIO, INC
Entity Type:Organization
Organization Name:THE CONTINUUM OF CLIO, INC
Other - Org Name:DBA: MAPLE WOODS MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TRUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-686-2600
Mailing Address - Street 1:G13137 CLIO ROAD
Mailing Address - Street 2:PO BOX 40
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-0040
Mailing Address - Country:US
Mailing Address - Phone:810-686-2600
Mailing Address - Fax:810-686-8405
Practice Address - Street 1:G13137 CLIO ROAD
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-0040
Practice Address - Country:US
Practice Address - Phone:810-686-2600
Practice Address - Fax:810-686-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
313M00000X
MI254030314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4151200Medicaid
MI23-5518Medicare PIN
MI4151200Medicaid