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Organization
FOUNTAIN GATE HEALTH LLC
Active
Organization
FOUNTAIN GATE HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EVELYN MCCARTHY (CEO)
(763) 516-8304
Entity
Organization
Contact information
Practice address
10714 ILEX ST NW, COON RAPIDS, MN 55448-4941
(763) 516-8304
Mailing address
10714 ILEX ST NW, COON RAPIDS, MN 55448-4941
(763) 516-8304
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
310400000X
Assisted Living Facility
Primary
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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