Organization
FOUNTAIN HOMECARE PROVIDERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY N GIBSON (PRESIDENT)
(804) 549-0490
Entity
Organization
Contact information
Practice address
317 PERSHING AVE, COLLINGDALE, PA 19023-4116
(804) 549-0490
Mailing address
317 PERSHING AVE, COLLINGDALE, PA 19023-4116
(804) 549-0490
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
03/02/2022
Last updated
03/02/2022
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