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General NPI Number Information
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NPI Number | 1437880770
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Entity Type | Organization
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Legal Business Name | FOUNTAIN HEALTH SERVICES INC.
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Dates
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Enumeration Date | 06/17/2022
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 330 W 24TH ST STE D
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City | BALTIMORE
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State | MD
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Zip | 21211-3216
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Country | US
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Telephone | 443-525-2019
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Fax | 410-630-3600
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Provider Business Mailing Address
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Address Line | 1305 SUDVALE RD
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City | PIKESVILLE
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State | MD
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Zip | 21208-4114
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Country | US
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Telephone | 443-525-2019
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Fax | 410-630-3600
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Authorized Official
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Title or Position | CEO
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Name | OLANIKE K OSUNNUYI
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Credential |
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Telephone | 443-525-2019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 273Y00000X
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Taxonomy Name | Rehabilitation Hospital Unit
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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