Healthcare Provider Details

I. General information

NPI: 1083491344
Provider Name (Legal Business Name): FOUNT OF LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 CALEDON WAY
HAMPTON GA
30228
US

IV. Provider business mailing address

580 CALEDON WAY
HAMPTON GA
30228-5338
US

V. Phone/Fax

Practice location:
  • Phone: 888-260-4205
  • Fax:
Mailing address:
  • Phone: 888-306-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MARQUIDA SIMS
Title or Position: CEO
Credential:
Phone: 470-661-5505