Provider Demographics
NPI:1992881585
Name:FOUNTAIN VIEW ASSISTED LIVING
Entity type:Organization
Organization Name:FOUNTAIN VIEW ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:ZENOR
Authorized Official - Suffix:
Authorized Official - Credentials:RNBC, MS, NHA
Authorized Official - Phone:712-276-3821
Mailing Address - Street 1:5501 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-2008
Mailing Address - Country:US
Mailing Address - Phone:712-276-3821
Mailing Address - Fax:712-202-0410
Practice Address - Street 1:5501 GORDON DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-2008
Practice Address - Country:US
Practice Address - Phone:712-276-3821
Practice Address - Fax:712-202-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAS0172310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS0172OtherCERTIFICATION NUMBER