Organization
FOUNTAIN OF HOPE LLC
Active
Other names
Fountain of Hope Personal Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHYNDONA LYNETTE DICKERSON (ADMINISTRATOR)
(702) 604-2448
Entity
Organization
Contact information
Practice address
2300 W SAHARA AVE STE 800, LAS VEGAS, NV 89102-4397
(702) 604-2448
(725) 605-5874
Mailing address
2300 W SAHARA AVE STE 800, LAS VEGAS, NV 89102-4397
(702) 604-2448
(725) 605-5874
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10472-PCS-1
DEPARTMENT PUBLIC BEHAVIOR HEALTH
NV
05
—
250017446
—
NV
01
—
505TW76717
MEDICARE TRI WEST
NV
Enumeration date
07/20/2021
Last updated
09/24/2024
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