Provider Demographics
NPI:1922001221
Name:THE FOUNTAINVIEW
Entity Type:Organization
Organization Name:THE FOUNTAINVIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP BILLER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-661-6800
Mailing Address - Street 1:250 PARK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-1316
Mailing Address - Country:US
Mailing Address - Phone:216-661-6800
Mailing Address - Fax:216-739-3789
Practice Address - Street 1:250 PARK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-1316
Practice Address - Country:US
Practice Address - Phone:216-661-6800
Practice Address - Fax:216-739-3789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6394314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2386430Medicaid
OH2386430Medicaid