Healthcare Provider Details

I. General information

NPI: 1063746790
Provider Name (Legal Business Name): CLIFTON HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 LONG LAKE ROAD
NEW BRIGHTON MN
55112-6430
US

IV. Provider business mailing address

1200 LONG LAKE ROAD
NEW BRIGHTON MN
55112-6430
US

V. Phone/Fax

Practice location:
  • Phone: 651-379-0100
  • Fax: 651-379-0601
Mailing address:
  • Phone: 651-379-0100
  • Fax: 651-379-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number345904
License Number StateMN

VIII. Authorized Official

Name: SUZANNE GIVENS
Title or Position: ADMINISTRATOR
Credential:
Phone: 651-379-0100