Provider Demographics
NPI:1801074372
Name:FOUNTAIN VIEW CARE CENTER
Entity type:Organization
Organization Name:FOUNTAIN VIEW CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CLARKL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-346-2008
Mailing Address - Street 1:200 VINE STREET
Mailing Address - Street 2:PO BOX 349
Mailing Address - City:FORSYTH
Mailing Address - State:MT
Mailing Address - Zip Code:59327
Mailing Address - Country:US
Mailing Address - Phone:406-346-2008
Mailing Address - Fax:
Practice Address - Street 1:200 VINE STREET
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MT
Practice Address - Zip Code:59327
Practice Address - Country:US
Practice Address - Phone:406-346-2008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11406310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility