# FOUNTAIN OF LOVE HOME CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174336937
- **Authorized official:** TYISHA MICHELLE BASKERVILLE (CEO)
- **Authorized official phone:** (757) 633-5245

## Contact information

- **Practice address:** 4371 LAKE PRINCE DR, SUFFOLK, VA 23434-6822
- **Practice address phone:** (757) 633-5245
- **Mailing address:** 4371 LAKE PRINCE DR, SUFFOLK, VA 23434-6822
- **Mailing address phone:** (757) 633-5245

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |
| 385H00000X | Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 01/27/2025
- **Last updated:** 01/27/2025