Organization
BARUCH SLS, INC.
Active
Other names
Fountain View Assisted Living - Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE L CLAUSON (VP OPERATIONS)
(616) 285-0573
Entity
Organization
Contact information
Practice address
640 W RANDALL ST, COOPERSVILLE, MI 49404-1306
(616) 997-9253
Mailing address
3196 KRAFT AVE SE STE 203, GRAND RAPIDS, MI 49512-2065
(616) 285-0573
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
23D0975401
MI
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D0975401
CLIA
MI
Enumeration date
10/20/2009
Last updated
02/20/2023
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