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General NPI Number Information
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NPI Number | 1386119683
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Entity Type | Organization
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Legal Business Name | FOUNTAIN OF HOPE L.L.C.
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Dates
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Enumeration Date | 10/12/2018
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Last Update Date | 06/03/2019
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Provider Practice Location Address
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Address Line | 268 DELTA WATERS ST
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City | HENDERSON
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State | NV
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Zip | 89074-8712
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Country | US
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Telephone | 725-400-4098
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Fax | 725-605-5874
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Provider Business Mailing Address
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Address Line | 268 DELTA WATERS ST
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City | HENDERSON
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State | NV
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Zip | 89074-8712
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Country | US
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Telephone | 725-400-4098
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Fax | 725-605-5874
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Authorized Official
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Title or Position | CEO
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Name | SHYNDONA YOUNG
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Credential |
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Telephone | 725-400-4098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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