Organization Name: | FOUNTAIN ADULT HOME CARE, LLC |
NPI Number: | 1295191450 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHIRLEY WALSTON MCNEIL (OWNER/ADMINISTRATOR) |
Mailing Address: | 303 William Walston Lane Tarboro |
State: | NC US |
Postal Code: | 27886 |
Phone Number: | 2526414388 |
Fax Number: | 2526416412 |
NPI Enumeration Date: | 01/04/2016 |
NPI Last Update Date: | 05/10/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 311ZA0620X |
License Number: | FCL033012 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Custodial Care Facility |
Taxonomy Specialization: | Adult Care Home |
Taxonomy Definition: | A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |