# FOUNTAIN PLACE REHAB INC

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

## Provider details

- **NPI number:** 1437169836
- **Authorized official:** ABEL C BORROMEO DC (OWNER)
- **Authorized official phone:** (304) 752-4045

## Contact information

- **Practice address:** 118 NICK SAVAS DR, LOGAN, WV 25601-3468
- **Practice address phone:** (304) 752-4045
- **Practice address fax:** (304) 752-4045
- **Mailing address:** 118 NICK SAVAS DR, LOGAN, WV 25601-3468
- **Mailing address phone:** (304) 752-4045
- **Mailing address fax:** (304) 752-4045

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/08/2006
- **Last updated:** 08/22/2020