Provider Demographics
NPI:1720380504
Name:FOUNTAIN OF LIFE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:FOUNTAIN OF LIFE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON/GENERAL PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:EKATA
Authorized Official - Last Name:OKUNADE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:832-922-0775
Mailing Address - Street 1:8307 ROYAL GROVE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-5464
Mailing Address - Country:US
Mailing Address - Phone:281-769-8297
Mailing Address - Fax:281-940-8823
Practice Address - Street 1:8307 ROYAL GROVE CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-5464
Practice Address - Country:US
Practice Address - Phone:281-769-8297
Practice Address - Fax:281-940-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health