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General NPI Number Information
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NPI Number | 1447694088
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Entity Type | Organization
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Legal Business Name | FOUNTAIN FAMILY INC
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Dates
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Enumeration Date | 04/25/2013
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 457 FLAT SHOALS AVE SE
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City | ATLANTA
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State | GA
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Zip | 30316-1962
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Country | US
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Telephone | 404-521-0404
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Fax | 404-521-0403
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Provider Business Mailing Address
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Address Line | 457 FLAT SHOALS AVE SE
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City | ATLANTA
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State | GA
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Zip | 30316-1962
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Country | US
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Telephone | 404-521-0404
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Fax | 404-521-0403
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY L WHITEHOUSE
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Credential |
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Telephone | 404-521-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 044R0549
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License Number State | GA
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