Organization
FOUNTAIN ADULT HOME CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHIRLEY WALSTON MCNEIL (OWNER/ADMINISTRATOR)
(252) 641-4388
Entity
Organization
Contact information
Practice address
303 WILLIAM WALSTON LANE, TARBORO, NC 27886
(252) 641-4388
(252) 641-6412
Mailing address
303 WILLIAM WALSTON LANE, TARBORO, NC 27886-8587
(252) 641-4388
(252) 641-6412
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
FCL033012
NC
Other
Enumeration date
01/04/2016
Last updated
05/10/2016
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