Provider Demographics
NPI:1801189063
Name:FOUNTAIN HOME HEALTH INC
Entity Type:Organization
Organization Name:FOUNTAIN HOME HEALTH INC
Other - Org Name:FOUNTAIN HOSPICE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHADIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-663-8411
Mailing Address - Street 1:4430 FOUNTAIN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2005
Mailing Address - Country:US
Mailing Address - Phone:323-663-8411
Mailing Address - Fax:323-663-8455
Practice Address - Street 1:4430 FOUNTAIN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2005
Practice Address - Country:US
Practice Address - Phone:323-663-8411
Practice Address - Fax:323-663-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based