Provider Demographics
NPI:1497990634
Name:FOUNTAIN HOME HEALTH INC
Entity Type:Organization
Organization Name:FOUNTAIN HOME HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHACHAKYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-548-1818
Mailing Address - Street 1:15820 N 35TH AVE STE 28
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-7607
Mailing Address - Country:US
Mailing Address - Phone:602-548-1818
Mailing Address - Fax:602-545-1819
Practice Address - Street 1:15820 N 35TH AVE STE 28
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-7607
Practice Address - Country:US
Practice Address - Phone:602-548-1818
Practice Address - Fax:602-545-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health