Organization
FOUNTAIN CARE CENTER, LLC
Active
Parent organization
SUMMIT CARE LLC
Other names
Fountain Care Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
SUMMIT CARE LLC
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
1835 WEST LA VETA AVENUE, ORANGE, CA 92868
(714) 978-6800
(714) 978-2544
Mailing address
1835 WEST LA VETA AVENUE, ORANGE, CA 92868
(714) 978-6800
(714) 978-2544
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
080000646
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC555259G
—
CA
Enumeration date
04/10/2006
Last updated
01/27/2016
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