Provider Demographics
NPI:1083864722
Name:FOUNTAIN BLEU NURSING & REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:FOUNTAIN BLEU NURSING & REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-255-2273
Mailing Address - Street 1:25440 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3881
Mailing Address - Country:US
Mailing Address - Phone:313-255-2273
Mailing Address - Fax:313-255-2425
Practice Address - Street 1:19175 ANGLIN ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-1407
Practice Address - Country:US
Practice Address - Phone:313-892-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility