Provider Demographics
NPI:1497984744
Name:FOUNTAIN RECOVERY
Entity Type:Organization
Organization Name:FOUNTAIN RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHULETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-292-5583
Mailing Address - Street 1:4049 1ST ST STE 123
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-4949
Mailing Address - Country:US
Mailing Address - Phone:925-292-5583
Mailing Address - Fax:
Practice Address - Street 1:4049 1ST ST STE 123
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-4949
Practice Address - Country:US
Practice Address - Phone:925-292-5583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROTHER AND SISTER PARTNERSHIP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-08
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA010095AP324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility