Provider Demographics
NPI:1972341337
Name:FOUNTAIN HEALTH CARE, LLC
Entity type:Organization
Organization Name:FOUNTAIN HEALTH CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AKINWUMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALAO
Authorized Official - Suffix:
Authorized Official - Credentials:MSC, PMP
Authorized Official - Phone:301-256-6624
Mailing Address - Street 1:5202 BALTIMORE NATIONAL PIKE STE 103&104
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-1022
Mailing Address - Country:US
Mailing Address - Phone:443-529-6015
Mailing Address - Fax:
Practice Address - Street 1:5202 BALTIMORE NATIONAL PIKE STE 103&104
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-1022
Practice Address - Country:US
Practice Address - Phone:443-529-6015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)