Provider Demographics
NPI:1477275642
Name:FOUNTAIN HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:FOUNTAIN HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLANIKE
Authorized Official - Middle Name:K
Authorized Official - Last Name:OSUNNUYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-525-2019
Mailing Address - Street 1:1305 SUDVALE RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4114
Mailing Address - Country:US
Mailing Address - Phone:443-525-2019
Mailing Address - Fax:
Practice Address - Street 1:330 W 24TH ST STE D
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-3216
Practice Address - Country:US
Practice Address - Phone:443-525-2019
Practice Address - Fax:410-630-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No273R00000XHospital UnitsPsychiatric Unit