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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MI | 23D2147650 | Other | CLIA |