Provider Demographics
NPI:1417137225
Name:NATALIE AND ERIK TILTINS
Entity Type:Organization
Organization Name:NATALIE AND ERIK TILTINS
Other - Org Name:FOUNTAIN HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TILTINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-722-0084
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:FL
Mailing Address - Zip Code:32438-0500
Mailing Address - Country:US
Mailing Address - Phone:850-722-0084
Mailing Address - Fax:850-722-0203
Practice Address - Street 1:17919 HIGHWAY 231
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:FL
Practice Address - Zip Code:32438-0500
Practice Address - Country:US
Practice Address - Phone:850-722-0084
Practice Address - Fax:850-722-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5222310500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310500000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Mental Illness