MEDICARE: FOUNTAIN VIEW 215 TENANT, 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	864	LA

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

General Provider Information

NPI Number	:	1881693489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNTAIN VIEW 215 TENANT, LLC

Provider Business Mailing Address
First Line	:	215 1ST ST NE
Second Line	:
City	:	SPRINGHILL
State	:	LA
Zip	:	71075-3217
Country	:	US
Telephone Number	:	318-539-3956
Fax Number	:	318-539-3583

Provider Business Practice Location Address
First Line	:	215 1ST ST NE
Second Line	:
City	:	SPRINGHILL
State	:	LA
Zip	:	71075-3217
Country	:	US
Telephone Number	:	318-539-3956
Fax Number	:	318-539-3583

Authorized Official
Title or Position	:	COO
Name	:	MR. ALEX PALEY
Credential	:
Telephone Number	:	914-390-4363

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	02/12/2008

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