Provider Demographics
NPI:1942271465
Name:FOUNTAINVIEW CENTER LP
Entity Type:Organization
Organization Name:FOUNTAINVIEW CENTER LP
Other - Org Name:THE FOUNTAINVIEW CENTER FOR ALZHEIMER'S DISEASE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:404-325-7994
Mailing Address - Street 1:2631 N DRUID HILLS RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3529
Mailing Address - Country:US
Mailing Address - Phone:404-325-7994
Mailing Address - Fax:404-325-1213
Practice Address - Street 1:2631 N DRUID HILLS RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3529
Practice Address - Country:US
Practice Address - Phone:404-325-7994
Practice Address - Fax:404-325-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2-044-459314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00421429AMedicaid
GA71-01338OtherUNITED HLTHCARE-EVERCARE
GA71-01338OtherUNITED HLTHCARE-EVERCARE