MEDICARE: FOUNTAIN HOME HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	980001383	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013916063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNTAIN HOME HEALTH INC

Provider Business Mailing Address
First Line	:	8349 FOOTHILL BLVD STE B
Second Line	:
City	:	SUNLAND
State	:	CA
Zip	:	91040-2828
Country	:	US
Telephone Number	:	833-224-5538
Fax Number	:	833-424-5538

Provider Business Practice Location Address
First Line	:	8349 FOOTHILL BLVD STE B
Second Line	:
City	:	SUNLAND
State	:	CA
Zip	:	91040-2828
Country	:	US
Telephone Number	:	833-224-5538
Fax Number	:	833-424-5538

Authorized Official
Title or Position	:	CEO
Name	:	ARMEN GHADIMIAN
Credential	:
Telephone Number	:	833-224-5538

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	02/04/2020

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Directions to “FOUNTAIN HOME HEALTH INC ” Practice Location

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