Healthcare Provider Details

I. General information

NPI: 1104740885
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: 410-529-6015
  • Fax:
Mailing address:
  • Phone: 410-529-6015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. AKINWUMI ALAO
Title or Position: CEO
Credential: MSC
Phone: 443-529-6015