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General NPI Number Information
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NPI Number | 1699912964
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Entity Type | Organization
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Legal Business Name | FOUNTAIN PARK INN, BUCYRUS
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Dates
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Enumeration Date | 01/08/2009
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 500 WEDGEWOOD CT
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City | BUCYRUS
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State | OH
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Zip | 44820-3493
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Country | US
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Telephone | 419-562-6080
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Fax | 419-562-5080
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Provider Business Mailing Address
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Address Line | 500 WEDGEWOOD CT
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City | BUCYRUS
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State | OH
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Zip | 44820-3493
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Country | US
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Telephone | 419-562-6080
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Fax | 419-562-5080
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHEILA LYNN SABO
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Credential |
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Telephone | 941-270-7627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 2430R
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License Number State | OH
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