Provider Demographics
NPI:1326561432
Name:FOUNTAINS LEASING, LLC
Entity Type:Organization
Organization Name:FOUNTAINS LEASING, LLC
Other - Org Name:THE FOUNTAINS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELI
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUNZBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-658-1040
Mailing Address - Street 1:29225 CHAGRIN BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4632
Mailing Address - Country:US
Mailing Address - Phone:440-658-1040
Mailing Address - Fax:216-282-0729
Practice Address - Street 1:1555 BRAINARD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-3098
Practice Address - Country:US
Practice Address - Phone:216-367-1214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2089R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility