Organization
FOUNTAIN VIEW OF FREMONT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM MILLER (ADMINISTRATOR)
(231) 924-5050
Entity
Organization
Contact information
Practice address
102 HILLCREST AVE, FREMONT, MI 49412-1348
(231) 924-5050
Mailing address
3196 KRAFT AVE SE, SUITE 200, GRAND RAPIDS, MI 49512-2078
(616) 464-1564
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL620007296
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D0975403
CLIA
MI
Enumeration date
11/24/2009
Last updated
11/24/2009
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