Organization
LIFE FOUNTAIN HEALTH CARE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ADEGBOLA ADEJISOLA ADEGOKE (OWNER)
(314) 454-6865
Entity
Organization
Contact information
Practice address
1115 NEW HALLS FERRY RD, 202, SAINT LOUIS, MO 63033
(314) 830-3840
(314) 830-3820
Mailing address
11115 NEW HALLS FERRY RD, 202, FLORISSANT, MO 63033-7613
(314) 830-3840
(314) 830-3820
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
267611
PTAN NUMBER
—
Enumeration date
05/23/2006
Last updated
04/05/2016
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