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NPI Code Detail

MEDICARE: CLIFFSIDE COMPANY L L C

MEDICARE: CLIFFSIDE COMPANY L L C
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
1314000000XSkilled Nursing Facility1070000420MI
2313M00000XNursing Facility/Intermediate Care Facility114184MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
109937OTHERMIBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1801962097
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLIFFSIDE COMPANY L L C
Provider Business Mailing Address
First Line : 910 S WASHINGTON AVE
Second Line :
City : ROYAL OAK
State : MI
Zip : 48067-3216
Country : US
Telephone Number : 248-543-7300
Fax Number : 248-399-5300
Provider Business Practice Location Address
First Line : 3905 LORRAINE PATH
Second Line :
City : SAINT JOSEPH
State : MI
Zip : 49085-8630
Country : US
Telephone Number : 269-428-1111
Fax Number : 269-556-9684
Authorized Official
Title or Position : OWNER
Name : DAVID J HARTMAN
Credential :
Telephone Number : 773-259-1600
Provider Enumeration Date : 11/28/2006
Last Update Date : 02/18/2025

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Directions to “CLIFFSIDE COMPANY L L C ” Practice Location

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