Organization
BARUCH SLS, INC.
Active
Parent organization
BARUCH SLS, INC.
Other names
FountainView Assisted Living
Organization subpart
Yes
Provider details
NPI number
Legal business name
BARUCH SLS, INC.
Authorized official
MRS. CONNIE L CLAUSON (DIRECTOR OF OPERATIONS)
(616) 285-0573
Entity
Organization
Contact information
Practice address
640 W RANDALL ST, COOPERSVILLE, MI 49404-1306
(616) 997-9253
(616) 997-7234
Mailing address
3196 KRAFT AVE SE, SUITE 200, GRAND RAPIDS, MI 49512-2078
(616) 285-0573
(616) 464-2470
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL700070219
MI
310400000X
Assisted Living Facility
AL700070220
MI
310400000X
Assisted Living Facility
AL700088278
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D0975401
CLIA WAIVER ID
MI
05
—
5197796
—
MI
05
—
5197876
—
MI
05
—
6967688
—
MI
Enumeration date
03/27/2007
Last updated
03/10/2009
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