Provider Demographics
NPI:1063746790
Name:CLIFTON HOUSE INC
Entity type:Organization
Organization Name:CLIFTON HOUSE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-379-0100
Mailing Address - Street 1:1200 LONG LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6430
Mailing Address - Country:US
Mailing Address - Phone:651-379-0100
Mailing Address - Fax:651-379-0601
Practice Address - Street 1:1200 LONG LAKE ROAD
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-6430
Practice Address - Country:US
Practice Address - Phone:651-379-0100
Practice Address - Fax:651-379-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN345904282J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282J00000XHospitalsReligious Nonmedical Health Care Institution