Organization
CLOVER LAKE MANAGEMENT LLC
Active
Other names
Plaza at Clover Lake
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES EDOUARD GROS (MANAGING MEMBER)
(718) 360-8083
Entity
Organization
Contact information
Practice address
838 FAIR ST, CARMEL, NY 10512-3085
(845) 878-4111
Mailing address
838 FAIR ST, CARMEL, NY 10512-3085
(845) 878-4111
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
580F001
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03547748
—
NY
Enumeration date
09/23/2016
Last updated
09/23/2016
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