# CLIFFSIDE COMPANY L L C

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Coventry House Inn
- **Organization subpart:** No

## Provider details

- **NPI number:** 1801962097
- **Authorized official:** DAVID J HARTMAN (OWNER)
- **Authorized official phone:** (773) 259-1600

## Contact information

- **Practice address:** 3905 LORRAINE PATH, SAINT JOSEPH, MI 49085-8630
- **Practice address phone:** (269) 428-1111
- **Practice address fax:** (269) 556-9684
- **Mailing address:** 910 S WASHINGTON AVE, ROYAL OAK, MI 48067-3216
- **Mailing address phone:** (248) 543-7300
- **Mailing address fax:** (248) 399-5300

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 114184 | MI | Yes |
| 314000000X | Skilled Nursing Facility | 1070000420 | MI | — |

## Other

- **Enumeration date:** 11/28/2006
- **Last updated:** 02/18/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 09937 | BLUE CROSS BLUE SHIELD | MI |