Healthcare Provider Details

I. General information

NPI: 1942271465
Provider Name (Legal Business Name): FOUNTAINVIEW CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2631 N DRUID HILLS RD NE
ATLANTA GA
30329-3529
US

IV. Provider business mailing address

2631 N DRUID HILLS RD NE
ATLANTA GA
30329-3529
US

V. Phone/Fax

Practice location:
  • Phone: 404-325-7994
  • Fax: 404-325-1213
Mailing address:
  • Phone: 404-325-7994
  • Fax: 404-325-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2-044-459
License Number StateGA

VIII. Authorized Official

Name: MS. LINDA G KIMBALL
Title or Position: EXECUTIVE DIRECTOR
Credential: LNHA
Phone: 404-325-7994