# FOUNTAIN VIEW MANOR, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124026448
- **Authorized official:** MRS. JENNIFER MICHELLE CLASON LPN, NHADM. (ADM.)
- **Authorized official phone:** (918) 652-7021

## Contact information

- **Practice address:** 107 E BARCLAY ST, HENRYETTA, OK 74437-5609
- **Practice address phone:** (918) 652-7021
- **Practice address fax:** (918) 652-7216
- **Mailing address:** 107 E BARCLAY ST, P.O. BOX 520, HENRYETTA, OK 74437-5609
- **Mailing address phone:** (918) 652-7021
- **Mailing address fax:** (918) 652-7216

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311500000X | Alzheimer Center (Dementia Center) | NH56035603 | OK | — |
| 313M00000X | Nursing Facility/Intermediate Care Facility | NH56035603 | OK | — |
| 314000000X | Skilled Nursing Facility | 375462 | OK | Yes |

## Other

- **Enumeration date:** 07/11/2005
- **Last updated:** 06/20/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100773730A | — | OK |