MEDICARE: FOUNTAIN HEALTH CARE, LLC

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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)

General Provider Information

NPI Number	:	1972341337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNTAIN HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	5202 BALTIMORE NATIONAL PIKE STE 103&104
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-1022
Country	:	US
Telephone Number	:	443-529-6015
Fax Number	:

Provider Business Practice Location Address
First Line	:	5202 BALTIMORE NATIONAL PIKE STE 103&104
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21229-1022
Country	:	US
Telephone Number	:	443-529-6015
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	AKINWUMI ALAO
Credential	:	MSC, PMP
Telephone Number	:	301-256-6624

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	07/23/2024

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