Healthcare Provider Details

I. General information

NPI: 1437640471
Provider Name (Legal Business Name): FOUNTAIN INN NURSING & REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2018
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 WATERMAN WAY
TAVARES FL
32778
US

IV. Provider business mailing address

900 HOPE WAY
ALTAMONTE SPRINGS FL
32714-1502
US

V. Phone/Fax

Practice location:
  • Phone: 352-609-4000
  • Fax:
Mailing address:
  • Phone: 407-975-3000
  • Fax: 407-975-3090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DAVID RODMAN
Title or Position: ASST SECRETARY OF THE BOARD
Credential:
Phone: 407-975-3011