Organization
CLIFFSIDE COMPANY L L C
Active
Other names
Coventry House Inn
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID J HARTMAN (OWNER)
(773) 259-1600
Entity
Organization
Contact information
Practice address
3905 LORRAINE PATH, SAINT JOSEPH, MI 49085-8630
(269) 428-1111
(269) 556-9684
Mailing address
910 S WASHINGTON AVE, ROYAL OAK, MI 48067-3216
(248) 543-7300
(248) 399-5300
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
114184
MI
314000000X
Skilled Nursing Facility
1070000420
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09937
BLUE CROSS BLUE SHIELD
MI
Enumeration date
11/28/2006
Last updated
02/18/2025
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