# FOUNTAIN ADULT HOME CARE, LLC

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

## Provider details

- **NPI number:** 1295191450
- **Authorized official:** MRS. SHIRLEY WALSTON MCNEIL (OWNER/ADMINISTRATOR)
- **Authorized official phone:** (252) 641-4388

## Contact information

- **Practice address:** 303 WILLIAM WALSTON LANE, TARBORO, NC 27886
- **Practice address phone:** (252) 641-4388
- **Practice address fax:** (252) 641-6412
- **Mailing address:** 303 WILLIAM WALSTON LANE, TARBORO, NC 27886-8587
- **Mailing address phone:** (252) 641-4388
- **Mailing address fax:** (252) 641-6412

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | FCL033012 | NC | Yes |

## Other

- **Enumeration date:** 01/04/2016
- **Last updated:** 05/10/2016