FOUNTAIN MANOR HEALTH & REHABILITATION CENTER
NPI 1366960254
Skilled Nursing Facility in North Miami, FL

Active since August 31, 2017CLIA 10D2089235 · Waiver
390 NE 135TH ST, NORTH MIAMI, FL 33161(305) 895-4804 Get Directions Write a Review

NPPES record last updated: August 31, 2017. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Fountain Manor Health & Rehabilitation Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FOUNTAIN MANOR HEALTH & REHABILITATION CENTER (NPI 1366960254) is a healthcare organization registered as a skilled nursing facility in North Miami, Florida and active in the NPI registry since August 2017. The organization holds a CLIA Waiver certificate valid through December 22, 2026 and lists Cameron Marsh, Corporate Finance, as its authorized official.

NPPES Registry Identity

NPI1366960254
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameFOUNTAIN MANOR OPCO LLC
Location Address390 NE 135TH STNorth Miami, FL 33161-3967
Mailing Address480 Fentress Blvd Ste HDaytona Beach, FL 32114-1237
Organization SubpartNo
Authorized OfficialCameron MarshCorporate Finance · (386) 255-1054
Enumeration DateAugust 31, 2017
NPI 1366960254 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
390 NE 135TH ST, North Miami, FL 33161

Other Names 1

Doing Business AsFountain Manor Health & Rehabilitation Center

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2089235

Fountain Manor Health And Rehab Center · North Miami, FL
Active · expires Dec 22, 2026
CLIA Number10D2089235
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateDecember 23, 2024
Certificate Expiration DateDecember 22, 2026
Laboratory DirectorSamuel S. Chavin
Laboratory Phone(305) 895-4804
Laboratory LocationFountain Manor Health And Rehab Center390 NE 135th St, North Miami, FL 33161
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Psychiatry & Neurology (Psychiatry)
390 NE 135TH ST
NORTH MIAMI, FL 33161
Internal Medicine (Nephrology)
390 NE 135TH ST
NORTH MIAMI, FL 33161
Nurse Practitioner (Family)
390 NE 135TH ST
NORTH MIAMI, FL 33161
Skilled Nursing Facility
390 NE 135TH ST
NORTH MIAMI, FL 33161
Internal Medicine (Cardiovascular Disease)
390 NE 135TH ST
NORTH MIAMI, FL 33161
Skilled Nursing Facility
390 NE 135TH ST
NORTH MIAMI, FL 33161
Family Medicine
390 NE 135TH ST
NORTH MIAMI, FL 33161
Nurse Practitioner (Family)
390 NE 135TH ST
MIAMI, FL 33161

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fountain Manor Opco LLC's NPI number?

The NPI number for Fountain Manor Opco LLC is 1366960254. It was assigned to this organization in the NPPES registry on August 31, 2017. The provider is doing business as Fountain Manor Health & Rehabilitation Center.

Where is Fountain Manor Opco LLC located?

Fountain Manor Opco LLC is located at 390 NE 135th St, North Miami, FL 33161. The listed phone number is (305) 895-4804.

What is Fountain Manor Opco LLC's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Fountain Manor Opco LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2089235) is associated with this NPI, valid through December 22, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Fountain Manor Opco LLC was last updated on August 31, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.