# CCLA9, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Riverview health & Rehab Center Vent Unit
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790030690
- **Authorized official:** MR. TIM KAMEGO (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (313) 342-1200

## Contact information

- **Practice address:** 7733 E JEFFERSON AVE, DETROIT, MI 48214-3707
- **Practice address phone:** (248) 385-0559
- **Practice address fax:** (248) 593-9941
- **Mailing address:** 7733 E JEFFERSON AVE, DETROIT, MI 48214-3707
- **Mailing address phone:** (313) 432-1200
- **Mailing address fax:** (313) 432-1300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 07/17/2012
- **Last updated:** 01/14/2025