Organization
FOUNTAIN MANOR OPCO LLC
Active
Other names
Fountain Manor Health & Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
CAMERON MARSH (CORPORATE FINANCE)
(386) 255-1054
Entity
Organization
Contact information
Practice address
390 NE 135TH ST, NORTH MIAMI, FL 33161-3967
(305) 895-4804
Mailing address
480 FENTRESS BLVD STE H, DAYTONA BEACH, FL 32114-1237
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
08/31/2017
Last updated
08/31/2017
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