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General NPI Number Information
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NPI Number | 1366436453
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Entity Type | Organization
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Legal Business Name | FOUR FOUNTAINS CONVALESCENT CENTER
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 03/24/2009
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Provider Practice Location Address
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Address Line | 101 S BELT W
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City | BELLEVILLE
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State | IL
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Zip | 62220-2503
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Country | US
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Telephone | 618-277-7700
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Fax | 618-355-4050
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Provider Business Mailing Address
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Address Line | 101 S BELT W
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City | BELLEVILLE
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State | IL
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Zip | 62220-2503
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Country | US
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Telephone | 618-277-7700
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Fax | 618-355-4050
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Authorized Official
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Title or Position | LICENSED NURSING HOME ADMINISTRATOR
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Name | MRS. HOPE A MCNITT
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Credential | R.N. L.N.H.A.
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Telephone | 618-277-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number | 0030304
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License Number State | IL
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