Organization
FOUNTAIN VIEW OF PORTAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY DENNY (ADMINISTRATOR)
(269) 327-9595
Entity
Organization
Contact information
Practice address
7818 KENMURE DR, PORTAGE, MI 49024-5082
(269) 327-9595
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
AL390007092
MI
310400000X
Assisted Living Facility
AL390016015
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23D0975380
CLIA
MI
Enumeration date
11/17/2009
Last updated
11/17/2009
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