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General NPI Number Information
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NPI Number | 1952693988
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Entity Type | Organization
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Legal Business Name | FOUNTAIN OF CARE, LLC
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 09/12/2014
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Provider Practice Location Address
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Address Line | 29225 HERITAGE CT
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City | SOUTHFIELD
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State | MI
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Zip | 48076-1743
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Country | US
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Telephone | 313-969-5128
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Fax | 248-785-3623
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Provider Business Mailing Address
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Address Line | 29225 HERITAGE CT
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City | SOUTHFIELD
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State | MI
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Zip | 48076-1743
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Country | US
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Telephone | 313-969-5128
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Fax | 248-785-3623
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | MRS. LORI N CLARK
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Credential |
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Telephone | 313-969-5128
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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