Provider Demographics
NPI:1134699242
Name:FOUNTAIN SPRINGS HEALTHCARE CORP
Entity type:Organization
Organization Name:FOUNTAIN SPRINGS HEALTHCARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PONI
Authorized Official - Last Name:CORNELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-479-1418
Mailing Address - Street 1:637 LAKE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-4212
Mailing Address - Country:US
Mailing Address - Phone:615-479-1418
Mailing Address - Fax:
Practice Address - Street 1:637 LAKE TERRACE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-4212
Practice Address - Country:US
Practice Address - Phone:615-479-1418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness