Healthcare Provider Details

I. General information

NPI: 1730796558
Provider Name (Legal Business Name): BARUCH SLS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MARY ANN ST
GRAYLING MI
49738-7037
US

IV. Provider business mailing address

3196 KRAFT AVE SE STE 203
GRAND RAPIDS MI
49512-2065
US

V. Phone/Fax

Practice location:
  • Phone: 989-344-2010
  • Fax:
Mailing address:
  • Phone: 616-285-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

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