Healthcare Provider Details

I. General information

NPI: 1801962097
Provider Name (Legal Business Name): CLIFFSIDE COMPANY L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 02/18/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 LORRAINE PATH
SAINT JOSEPH MI
49085-8630
US

IV. Provider business mailing address

910 S WASHINGTON AVE
ROYAL OAK MI
48067-3216
US

V. Phone/Fax

Practice location:
  • Phone: 269-428-1111
  • Fax: 269-556-9684
Mailing address:
  • Phone: 248-543-7300
  • Fax: 248-399-5300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1070000420
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number114184
License Number StateMI

VIII. Authorized Official

Name: DAVID J HARTMAN
Title or Position: OWNER
Credential:
Phone: 773-259-1600