Provider Demographics
NPI:1639264500
Name:FOUNTAINS HOME HEALTHCARE, INC
Entity Type:Organization
Organization Name:FOUNTAINS HOME HEALTHCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-310-0538
Mailing Address - Street 1:2974 LBJ FRWY
Mailing Address - Street 2:SUITE 495
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234
Mailing Address - Country:US
Mailing Address - Phone:469-310-0538
Mailing Address - Fax:469-310-0539
Practice Address - Street 1:2974 LBJ FRWY
Practice Address - Street 2:SUITE 495
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234
Practice Address - Country:US
Practice Address - Phone:469-310-0538
Practice Address - Fax:469-310-0539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009024251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171342201Medicaid
453173Medicare UPIN