Provider Demographics
NPI:1558768986
Name:FOUNTAIN HOME HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:FOUNTAIN HOME HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:GITONGA
Authorized Official - Last Name:WANGANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-943-2817
Mailing Address - Street 1:160 WINTHROP AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-3840
Mailing Address - Country:US
Mailing Address - Phone:603-943-2817
Mailing Address - Fax:
Practice Address - Street 1:160 WINTHROP AVE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-3840
Practice Address - Country:US
Practice Address - Phone:603-943-2817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health