Healthcare Provider Details

I. General information

NPI: 1053262352
Provider Name (Legal Business Name): FOUNTAIN HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 EAGLE PARK DR NE STE 104
GRAND RAPIDS MI
49525-7057
US

IV. Provider business mailing address

3200 EAGLE PARK DR NE STE 104
GRAND RAPIDS MI
49525-7057
US

V. Phone/Fax

Practice location:
  • Phone: 616-288-1282
  • Fax: 616-288-1784
Mailing address:
  • Phone: 616-288-1282
  • Fax: 616-288-1784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC S SMITH
Title or Position: OWNER
Credential:
Phone: 616-799-9337