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General NPI Number Information
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NPI Number | 1154657591
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Entity Type | Organization
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Legal Business Name | BARUCH SLS, INC.
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 640 W RANDALL ST
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City | COOPERSVILLE
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State | MI
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Zip | 49404-1306
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Country | US
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Telephone | 616-997-9253
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Fax |
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Provider Business Mailing Address
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Address Line | 3196 KRAFT AVE SE STE 203
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City | GRAND RAPIDS
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State | MI
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Zip | 49512-2065
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Country | US
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Telephone | 616-285-0573
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Fax |
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Authorized Official
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Title or Position | VP OPERATIONS
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Name | CONNIE L CLAUSON
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Credential |
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Telephone | 616-285-0573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 23D0975401
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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