Basic Information
Provider Information
NPI: 1083039887
EntityType: 2
ReplacementNPI:  
OrganizationName: PINNACLE HEALTH FACILITIES XXXV LP
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: FOUNTAINVIEW NURSING AND REHABILITATION CENTER ALF
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5420 W PLANO PKWY
Address2:  
City: PLANO
State: TX
PostalCode: 750934823
CountryCode: US
TelephoneNumber: 9729313800
FaxNumber: 9727676222
Practice Location
Address1: 603 N ROSE HILL RD
Address2:  
City: ROSE HILL
State: KS
PostalCode: 671339336
CountryCode: US
TelephoneNumber: 3167760058
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/03/2014
LastUpdateDate: 03/03/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: COLLIER
AuthorizedOfficialFirstName: JAMIE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR OF REIMBURSEMENT
AuthorizedOfficialTelephone: 9729313800
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
310400000XN008004KSY Nursing & Custodial Care FacilitiesAssisted Living Facility 

No ID Information.


Home