Healthcare Provider Details

I. General information

NPI: 1205750999
Provider Name (Legal Business Name): FOUNTAIN HEALTH CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

3235 OLD WASHINGTON RD STE 1&2
WALDORF MD
20602-3308
US

IV. Provider business mailing address

3235 OLD WASHINGTON RD STE 1&2
WALDORF MD
20602-3308
US

V. Phone/Fax

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