Provider Demographics
NPI:1528063666
Name:THE FOUNTAINS NURSING HOME INC.
Entity type:Organization
Organization Name:THE FOUNTAINS NURSING HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-244-0410
Mailing Address - Street 1:3800 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4523
Mailing Address - Country:US
Mailing Address - Phone:561-395-7510
Mailing Address - Fax:561-395-1517
Practice Address - Street 1:3800 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4523
Practice Address - Country:US
Practice Address - Phone:561-395-7510
Practice Address - Fax:561-395-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1165096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021239300Medicaid
FL021239300Medicaid
FL105101Medicare Oscar/Certification