Provider Demographics
NPI:1245709187
Name:FOUNTAIN HOMECARE SERVICES LLC
Entity type:Organization
Organization Name:FOUNTAIN HOMECARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EBUNAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLORUNTELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-626-0343
Mailing Address - Street 1:13775 GLENOAKS BLVD UNIT 11
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-8368
Mailing Address - Country:US
Mailing Address - Phone:818-626-0343
Mailing Address - Fax:
Practice Address - Street 1:18301 SHERMAN WAY # 13
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4425
Practice Address - Country:US
Practice Address - Phone:818-626-0343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care