Provider Demographics
NPI:1366285744
Name:FOUNTAIN OF LOVE CARE LLC
Entity type:Organization
Organization Name:FOUNTAIN OF LOVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FAUSTINUS
Authorized Official - Middle Name:
Authorized Official - Last Name:OKAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-209-7883
Mailing Address - Street 1:4216 VILLAGE BEND LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-6244
Mailing Address - Country:US
Mailing Address - Phone:317-603-3890
Mailing Address - Fax:
Practice Address - Street 1:4216 VILLAGE BEND LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-6244
Practice Address - Country:US
Practice Address - Phone:317-603-3890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care