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General NPI Number Information
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NPI Number | 1629387683
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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 | 09/24/2010
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 15255 CLOVERNOOK DR
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2959
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Country | US
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Telephone | 616-847-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 15255 CLOVERNOOK DR
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City | GRAND HAVEN
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State | MI
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Zip | 49417-2959
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Country | US
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Telephone | 616-847-4242
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Fax |
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Authorized Official
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Title or Position | SECRETARY / TREASURER
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Name | MR. CHRISTOPHER MURPHY
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Credential |
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Telephone | 616-464-1564
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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 | 23D2004739
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License Number State | MI
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