Organization
FOUNTAIN VILLA RESIDENTIAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOE C MONSOUR (OPERATOR)
(620) 365-6002
Entity
Organization
Contact information
Practice address
2620 N KENTUCKY ST, IOLA, KS 66749-1940
(620) 365-6002
(620) 365-3510
Mailing address
2620 N KENTUCKY ST, IOLA, KS 66749-1940
(620) 365-6002
(620) 365-3510
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
N001-006
KS
Other
Enumeration date
02/08/2007
Last updated
08/22/2020
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