MEDICARE: FOUNTAIN VIEW SUBACUTE & NURSING CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	970000008	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194767871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNTAIN VIEW SUBACUTE & NURSING CENTER, LLC

Provider Business Mailing Address
First Line	:	5310 FOUNTAIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1005
Country	:	US
Telephone Number	:	323-461-9961
Fax Number	:	323-461-6854

Provider Business Practice Location Address
First Line	:	5310 FOUNTAIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1005
Country	:	US
Telephone Number	:	323-461-9961
Fax Number	:	323-461-6854

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	MICHAEL T. BERG
Credential	:
Telephone Number	:	505-468-4752

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	06/05/2019

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