Organization
FOUNTAIN OF LIFE HEALTHCARE PC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHIDI ROOVELT NWACHUKWU (PROVIDER)
(410) 777-5292
Entity
Organization
Contact information
Practice address
7375 EXECUTIVE PL, LANHAM, MD 20706-2278
(301) 806-7473
(410) 988-2868
Mailing address
7375 EXECUTIVE PL, LANHAM, MD 20706-2278
(301) 806-7473
(410) 988-2868
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
03/22/2022
Last updated
07/13/2023
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