Provider Demographics
NPI:1063058469
Name:FOUNTAIN, TANAREA CHANTEL (HHA)
Entity type:Individual
Prefix:
First Name:TANAREA
Middle Name:CHANTEL
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CRESTLINE AVE APT 326
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-3067
Mailing Address - Country:US
Mailing Address - Phone:440-810-0820
Mailing Address - Fax:
Practice Address - Street 1:1400 CRESTLINE AVE APT 326
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-3067
Practice Address - Country:US
Practice Address - Phone:440-810-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator