Provider Demographics
NPI:1558669671
Name:FOUNTAIN OF LIFE HOUSING
Entity type:Organization
Organization Name:FOUNTAIN OF LIFE HOUSING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-320-2772
Mailing Address - Street 1:2319 PANNELL ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77026-6536
Mailing Address - Country:US
Mailing Address - Phone:713-320-2772
Mailing Address - Fax:
Practice Address - Street 1:2319 PANNELL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-6536
Practice Address - Country:US
Practice Address - Phone:713-320-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNTAIN OF LIFE MINISTRIES, INTERNATIONAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities