Provider Demographics
NPI:1417578030
Name:FOUNTAIN TRANSPORTATION LLC
Entity Type:Organization
Organization Name:FOUNTAIN TRANSPORTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONATUS
Authorized Official - Middle Name:OKWUDILI
Authorized Official - Last Name:AGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-892-7903
Mailing Address - Street 1:11100 BRAESRIDGE DR APT 2223
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2132
Mailing Address - Country:US
Mailing Address - Phone:832-892-7903
Mailing Address - Fax:
Practice Address - Street 1:11100 BRAESRIDGE DR APT 2223
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2132
Practice Address - Country:US
Practice Address - Phone:832-892-7903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)