Healthcare Provider Details

I. General information

NPI: 1932017423
Provider Name (Legal Business Name): FOUNTAIN OF COMFORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3166 S SEPULVEDA BLVD UNIT 20
LOS ANGELES CA
90034-4222
US

IV. Provider business mailing address

14500 ROSCOE BLVD FL 4
PANORAMA CITY CA
91402-4194
US

V. Phone/Fax

Practice location:
  • Phone: 310-849-8024
  • Fax:
Mailing address:
  • Phone: 310-849-8024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACOB FATURECHI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-849-8024