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General NPI Number Information
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NPI Number | 1962091686
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Entity Type | Organization
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Legal Business Name | FOUNTAIN OF HEALTH HOME HEALTH AGENCY LLC
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Dates
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Enumeration Date | 01/16/2021
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 5875 N LINCOLN AVE STE 243
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City | CHICAGO
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State | IL
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Zip | 60659-4668
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Country | US
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Telephone | 847-859-6217
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Fax | 847-859-6227
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Provider Business Mailing Address
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Address Line | 1420 BRUMMEL ST
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City | EVANSTON
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State | IL
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Zip | 60202-3706
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Country | US
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Telephone | 847-859-6217
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Fax | 847-859-6227
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | OLUGBENGA AYENI
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Credential |
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Telephone | 773-428-2259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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