Provider Demographics
NPI:1013524834
Name:BARUCH SLS, INC.
Entity type:Organization
Organization Name:BARUCH SLS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
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 1:3196 KRAFT AVE SE STE 203
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2065
Mailing Address - Country:US
Mailing Address - Phone:616-285-0573
Mailing Address - Fax:
Practice Address - Street 1:2801 CHARLEVOIX RD
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9727
Practice Address - Country:US
Practice Address - Phone:231-347-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARUCH SLS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-25
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23D2147650OtherCLIA