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General NPI Number Information
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NPI Number | 1194767871
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Entity Type | Organization
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Legal Business Name | FOUNTAIN VIEW SUBACUTE & NURSING CENTER, LLC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 5310 FOUNTAIN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90029-1005
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Country | US
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Telephone | 323-461-9961
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Fax | 323-461-6854
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Provider Business Mailing Address
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Address Line | 5310 FOUNTAIN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90029-1005
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Country | US
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Telephone | 323-461-9961
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Fax | 323-461-6854
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Authorized Official
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Title or Position | ASSISTANT SECRETARY
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Name | MICHAEL T. BERG
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Credential |
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Telephone | 505-468-4752
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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 | 970000008
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License Number State | CA
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