MEDICARE: CLIFT ROACH II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker		MI

General Provider Information

NPI Number	:	1306705728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLIFT ROACH II

Provider Business Mailing Address
First Line	:	19451 WESTMORELAND RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48219-2144
Country	:	US
Telephone Number	:	313-850-5474
Fax Number	:

Provider Business Practice Location Address
First Line	:	7111 W OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-3168
Country	:	US
Telephone Number	:	313-850-5474
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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Directions to “ CLIFT ROACH II ” Practice Location

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