Provider Demographics
NPI:1871741462
Name:FOUNTAIN VIEW MANOR LLC
Entity type:Organization
Organization Name:FOUNTAIN VIEW MANOR LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-931-3999
Mailing Address - Street 1:3432 VILLAGE LANE
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040
Mailing Address - Country:US
Mailing Address - Phone:618-931-3999
Mailing Address - Fax:618-797-0857
Practice Address - Street 1:3432 VILLAGE LANE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040
Practice Address - Country:US
Practice Address - Phone:618-931-3999
Practice Address - Fax:618-797-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)