Provider Demographics
NPI:1366717902
Name:CLIFFORD LLC
Entity type:Organization
Organization Name:CLIFFORD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-238-9431
Mailing Address - Street 1:PO BOX 1385
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48501-1385
Mailing Address - Country:US
Mailing Address - Phone:810-238-9431
Mailing Address - Fax:810-238-5288
Practice Address - Street 1:2039 CLIFFORD ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-4005
Practice Address - Country:US
Practice Address - Phone:810-238-9431
Practice Address - Fax:810-238-5288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM250082393253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency