Provider Demographics
NPI:1225297062
Name:SF FOUNTAINHEAD LLC
Entity Type:Organization
Organization Name:SF FOUNTAINHEAD LLC
Other - Org Name:FOUNTAINHEAD CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:ARI
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARKENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-390-4377
Mailing Address - Street 1:44 S BROADWAY
Mailing Address - Street 2:SUITE 614
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:390 NE 135TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-3967
Practice Address - Country:US
Practice Address - Phone:305-895-4804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA FACILITIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-06
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility