Provider Demographics
NPI:1982658498
Name:SL FOUNTAIN VIEW VILLAGE LLC
Entity Type:Organization
Organization Name:SL FOUNTAIN VIEW VILLAGE LLC
Other - Org Name:FOUNTAIN VIEW VILLAGE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIR. MEDICARE REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LICHTENWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-330-6434
Mailing Address - Street 1:111 E WACKER DR
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-3713
Mailing Address - Country:US
Mailing Address - Phone:312-673-4333
Mailing Address - Fax:312-673-4430
Practice Address - Street 1:16455 E AVENUE OF THE FOUNTAINS
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-8307
Practice Address - Country:US
Practice Address - Phone:480-836-4800
Practice Address - Fax:480-836-4876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035260Medicare Oscar/Certification