Provider Demographics
NPI:1689878563
Name:ELITE SENIOR LIVING - FOUNTAIN VIEW, LLC
Entity Type:Organization
Organization Name:ELITE SENIOR LIVING - FOUNTAIN VIEW, LLC
Other - Org Name:FOUNTAIN VIEW CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-748-7880
Mailing Address - Street 1:50 WOLVERTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:WI
Mailing Address - Zip Code:54971-1050
Mailing Address - Country:US
Mailing Address - Phone:920-748-5638
Mailing Address - Fax:
Practice Address - Street 1:50 WOLVERTON AVE
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:WI
Practice Address - Zip Code:54971-1050
Practice Address - Country:US
Practice Address - Phone:920-748-5638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI525551Medicare Oscar/Certification