Healthcare Provider Details

I. General information

NPI: 1972341337
Provider Name (Legal Business Name): FOUNTAIN HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5202 BALTIMORE NATIONAL PIKE STE 103&104
BALTIMORE MD
21229-1022
US

IV. Provider business mailing address

5202 BALTIMORE NATIONAL PIKE STE 103&104
BALTIMORE MD
21229-1022
US

V. Phone/Fax

Practice location:
  • Phone: 443-529-6015
  • Fax:
Mailing address:
  • Phone: 443-529-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AKINWUMI ALAO
Title or Position: CEO
Credential: MSC, PMP
Phone: 301-256-6624