Organization
FOUNTAIN VIEW MANOR, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER MICHELLE CLASON LPN, NHADM. (ADM.)
(918) 652-7021
Entity
Organization
Contact information
Practice address
107 E BARCLAY ST, HENRYETTA, OK 74437-5609
(918) 652-7021
(918) 652-7216
Mailing address
107 E BARCLAY ST, P.O. BOX 520, HENRYETTA, OK 74437-5609
(918) 652-7021
(918) 652-7216
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
NH56035603
OK
313M00000X
Nursing Facility/Intermediate Care Facility
NH56035603
OK
314000000X
Skilled Nursing Facility
Primary
375462
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100773730A
—
OK
Enumeration date
07/11/2005
Last updated
06/20/2013
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