Provider Demographics
NPI:1558310284
Name:FOUNTAIN CARE INC
Entity type:Organization
Organization Name:FOUNTAIN CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING / ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MUTIAT
Authorized Official - Middle Name:OLATUNDUN
Authorized Official - Last Name:LAWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-575-9505
Mailing Address - Street 1:9127 MAGNOLIA VW
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-6405
Mailing Address - Country:US
Mailing Address - Phone:281-575-9505
Mailing Address - Fax:281-495-0462
Practice Address - Street 1:9127 MAGNOLIA VW
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-6405
Practice Address - Country:US
Practice Address - Phone:281-575-9505
Practice Address - Fax:281-495-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX665509251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679479OtherMEDICARE
TX679479Medicare Oscar/Certification