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Organization
FOUNTAIN OF HOPE LLC
Active
Organization
FOUNTAIN OF HOPE LLC
Active
Other names
Fountain of Hope Personal Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHYNDONA LYNETTE DICKERSON (ADMINISTRATOR)
(702) 604-2448
Entity
Organization
Contact information
Practice address
2300 W SAHARA AVE STE 800, LAS VEGAS, NV 89102-4397
(702) 604-2448
(725) 605-5874
Mailing address
2300 W SAHARA AVE STE 800, LAS VEGAS, NV 89102-4397
(702) 604-2448
(725) 605-5874
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10472-PCS-1
DEPARTMENT PUBLIC BEHAVIOR HEALTH
NV
05
—
250017446
—
NV
01
—
505TW76717
MEDICARE TRI WEST
NV
Enumeration date
07/20/2021
Last updated
09/24/2024
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