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General NPI Number Information
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NPI Number | 1811276447
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Entity Type | Organization
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Legal Business Name | FOUNTAIN OF CARE INC.
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Dates
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Enumeration Date | 08/13/2011
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Last Update Date | 08/13/2011
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Provider Practice Location Address
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Address Line | 6127 PALOMAR CIR
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City | INDIANAPOLIS
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State | IN
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Zip | 46234-9062
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Country | US
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Telephone | 317-756-8176
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Fax | 317-602-5329
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Provider Business Mailing Address
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Address Line | 6127 PALOMAR CIR
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City | INDIANAPOLIS
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State | IN
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Zip | 46234-9062
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Country | US
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Telephone | 317-756-8176
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Fax | 317-602-5329
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Authorized Official
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Title or Position | CEO
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Name | GODWIN N NOBEL
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Credential | MD
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Telephone | 317-756-8176
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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 | 11-012640-1
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License Number State | IN
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