Provider Demographics
NPI:1811479330
Name:FOUNTAIN BLEU HEALTH AND REHABILITATION CENTER INC
Entity type:Organization
Organization Name:FOUNTAIN BLEU HEALTH AND REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-255-2273
Mailing Address - Street 1:25440 5 MILE RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3881
Mailing Address - Country:US
Mailing Address - Phone:313-255-2273
Mailing Address - Fax:313-255-2425
Practice Address - Street 1:28910 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2337
Practice Address - Country:US
Practice Address - Phone:734-425-4814
Practice Address - Fax:734-425-6024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility