Organization
FOUNTAIN OF LOVE HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYISHA MICHELLE BASKERVILLE (CEO)
(757) 633-5245
Entity
Organization
Contact information
Practice address
4371 LAKE PRINCE DR, SUFFOLK, VA 23434-6822
(757) 633-5245
Mailing address
4371 LAKE PRINCE DR, SUFFOLK, VA 23434-6822
(757) 633-5245
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
01/27/2025
Last updated
01/27/2025
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