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General NPI Number Information
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NPI Number | 1083864722
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Entity Type | Organization
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Legal Business Name | FOUNTAIN BLEU NURSING & REHABILITATION CENTER INC
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Dates
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Enumeration Date | 09/30/2008
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Last Update Date | 09/30/2008
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Provider Practice Location Address
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Address Line | 19175 ANGLIN ST
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City | DETROIT
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State | MI
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Zip | 48234-1407
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Country | US
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Telephone | 313-892-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 25440 5 MILE RD
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City | REDFORD
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State | MI
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Zip | 48239-3881
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Country | US
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Telephone | 313-255-2273
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Fax | 313-255-2425
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CHARLES A DUNN
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Credential |
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Telephone | 313-255-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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