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Baruch SLS, Inc.

Organization Active NPI Assisted Living Facility · Petoskey, MI

NPI 1013524834 · NPPES record last updated Feb 20, 2023

Key facts

NPI
1013524834
Entity type
Organization (NPI type 2)
Primary specialty
Assisted Living Facility 310400000X
Legal business name
BARUCH SLS, INC.
Practice address
2801 Charlevoix Rd
Petoskey, MI 49770-9727
Phone
(231) 347-2273
NPI assigned
Sep 25, 2020
Organization subpart
Yes
Parent organization (as reported)
BARUCH SLS, INC.

Authorized official

Name
Connie L Clauson
Title
VP Operations
Phone
(616) 285-0573

Corporate family (same tax ID) 19

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Baruch SLS Inc (20 organizations share this tax ID)
Part of
Baruch SLS Inc

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Yes

Addresses

Primary practice location

2801 Charlevoix Rd
Petoskey, MI 49770-9727

Mailing address

3196 Kraft Ave SE Ste 203
Grand Rapids, MI 49512-2065
Phone (616) 285-0573

Other identifiers

IdentifierTypeStateIssuer
23D2147650OtherMICLIA

Other names

  • Mallard Cove Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 20, 2023.

{
    "created_epoch": "1600992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676851200000",
    "number": "1013524834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3196 KRAFT AVE SE STE 203",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495122065",
            "telephone_number": "616-285-0573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 CHARLEVOIX RD",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497709727",
            "telephone_number": "231-347-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BARUCH SLS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BARUCH SLS, INC.",
        "enumeration_date": "2020-09-25",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A",
        "authorized_official_last_name": "CLAUSON",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VP OPERATIONS",
        "authorized_official_telephone_number": "616-285-0573"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "23D2147650",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mallard Cove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petoskey, MI

All providers in Petoskey, MI · Assisted Living Facility in Michigan

Sources for this page

Verify at the official NPI Registry.