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General NPI Number Information
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NPI Number | 1720196819
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Entity Type | Organization
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Legal Business Name | FOUNTAIN VIEW RETIREMENT
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 102 HILLCREST DR
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City | FREMONT
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State | MI
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Zip | 49412-1348
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Country | US
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Telephone | 231-924-5050
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Fax | 231-924-6445
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Provider Business Mailing Address
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Address Line | 102 HILLCREST DR
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City | FREMONT
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State | MI
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Zip | 49412-1348
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Country | US
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Telephone | 231-924-5050
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Fax | 231-924-6445
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Authorized Official
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Title or Position | ADMINISTRATOR/NURSE
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Name | MRS. DIANE MARIE GRAFF
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Credential | L.P.N.
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Telephone | 231-924-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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