Healthcare Provider Details

I. General information

NPI: 1528063666
Provider Name (Legal Business Name): THE FOUNTAINS NURSING HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 N FEDERAL HWY
BOCA RATON FL
33431-4523
US

IV. Provider business mailing address

3800 N FEDERAL HWY
BOCA RATON FL
33431-4523
US

V. Phone/Fax

Practice location:
  • Phone: 561-395-7510
  • Fax: 561-395-1517
Mailing address:
  • Phone: 561-395-7510
  • Fax: 561-395-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1165096
License Number StateFL

VIII. Authorized Official

Name: MR. DENNIS L MART
Title or Position: CFO
Credential:
Phone: 585-244-0410