Healthcare Provider Details

I. General information

NPI: 1013916063
Provider Name (Legal Business Name): FOUNTAIN HOME HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8349 FOOTHILL BLVD STE B
SUNLAND CA
91040-2828
US

IV. Provider business mailing address

8349 FOOTHILL BLVD STE B
SUNLAND CA
91040-2828
US

V. Phone/Fax

Practice location:
  • Phone: 833-224-5538
  • Fax: 833-424-5538
Mailing address:
  • Phone: 833-224-5538
  • Fax: 833-424-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number980001383
License Number StateCA

VIII. Authorized Official

Name: ARMEN GHADIMIAN
Title or Position: CEO
Credential:
Phone: 833-224-5538