Clover Lake Management LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

580F001 Issued in NY

Legal business name

CLOVER LAKE MANAGEMENT LLC

Doing business as

Plaza at Clover Lake

Practice address

838 Fair St
Carmel, NY 10512-3085

Phone

(845) 878-4111

NPI assigned

Sep 23, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Edouard Gros

Title

Managing Member

Phone

(718) 360-8083

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Plaza at Clover Lake Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474588800000",
    "number": "1558810259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "838 FAIR ST",
            "city": "CARMEL",
            "state": "NY",
            "postal_code": "105123085",
            "telephone_number": "845-878-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "838 FAIR ST",
            "city": "CARMEL",
            "state": "NY",
            "postal_code": "105123085",
            "telephone_number": "845-878-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVER LAKE MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-23",
        "last_updated": "2016-09-23",
        "status": "A",
        "authorized_official_last_name": "GROS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "EDOUARD",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "718-360-8083"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NY",
            "license": "580F001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03547748",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plaza at Clover Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa Renee Cioffi, P.T.
• Barbara G Circle, LMSW
• Kathleen Stiller Cirigliano, RN
• Maria Clear
• Georgia Molly Close, M.D.
• Sheilah Marcia Cocchiara
• Sara M Cohen, BA
• Stefanie Monica Cohen, LMSW
• Linda Collins, LPN
• Comprehensive Cardiac Care

• Assisted Living Facility in Carmel, NY
• Providers in Carmel, NY by specialty
• Assisted Living Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.