Healthcare Provider Details

I. General information

NPI: 1871145532
Provider Name (Legal Business Name): SPARKLING FOUNTAIN OF LOVE ADULT CARE HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 SWITZER ROAD
OVERLANDPARK KS
66214
US

IV. Provider business mailing address

8525 SWITZER ROAD
OVERLANDPARK KS
66214
US

V. Phone/Fax

Practice location:
  • Phone: 913-766-8526
  • Fax: 913-273-0242
Mailing address:
  • Phone: 913-766-8526
  • Fax: 913-273-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: PRISCILLA GITOMBO
Title or Position: RN/OPERATOR
Credential:
Phone: 913-766-8526