# FOUNTAIN PARK RIESEN CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FOUNTAIN PARK INN& VILLAS, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1356588248
- **Legal business name:** FOUNTAIN PARK INN& VILLAS, LLC
- **Authorized official:** SHEILA LYNN SABO (OWNER)
- **Authorized official phone:** (941) 270-7627

## Contact information

- **Practice address:** 1433 N MAIN ST, BRYAN, OH 43506-1053
- **Practice address phone:** (419) 633-9191
- **Practice address fax:** (419) 633-9192
- **Mailing address:** 1391 N MAIN ST, BRYAN, OH 43506-1057
- **Mailing address phone:** (419) 633-4315
- **Mailing address fax:** (419) 636-7287

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311500000X | Alzheimer Center (Dementia Center) | 2489R | OH | Yes |

## Other

- **Enumeration date:** 01/14/2009
- **Last updated:** 01/14/2009