Provider Demographics
NPI:1801962097
Name:CLIFFSIDE COMPANY L L C
Entity type:Organization
Organization Name:CLIFFSIDE COMPANY L L C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-259-1600
Mailing Address - Street 1:910 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3216
Mailing Address - Country:US
Mailing Address - Phone:248-543-7300
Mailing Address - Fax:248-399-5300
Practice Address - Street 1:3905 LORRAINE PATH
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8630
Practice Address - Country:US
Practice Address - Phone:269-428-1111
Practice Address - Fax:269-556-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1070000420314000000X
MI114184313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI09937OtherBLUE CROSS BLUE SHIELD
MI09937OtherBLUE CROSS BLUE SHIELD