Healthcare Provider Details

I. General information

NPI: 1043041973
Provider Name (Legal Business Name): BARUCH SLS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 LEONARD ST NE
GRAND RAPIDS MI
49505-5857
US

IV. Provider business mailing address

2106 LEONARD ST NE
GRAND RAPIDS MI
49505-5857
US

V. Phone/Fax

Practice location:
  • Phone: 616-818-4509
  • Fax: 616-818-4497
Mailing address:
  • Phone: 616-818-4509
  • Fax: 616-818-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CONNIE L CLAUSON
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 616-285-0573