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General NPI Number Information
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NPI Number | 1356009013
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Entity Type | Organization
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Legal Business Name | FOUNTAIN HOME HEALTH LLC
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Dates
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Enumeration Date | 11/30/2021
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 11137 FILLMORE ST NE
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City | BLAINE
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State | MN
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Zip | 55434-4524
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Country | US
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Telephone | 651-235-6942
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Fax |
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Provider Business Mailing Address
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Address Line | 11137 FILLMORE ST NE
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City | BLAINE
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State | MN
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Zip | 55434-4524
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BONIFACE MWANGI
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Credential |
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Telephone | 651-235-6942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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