Organization
FOUNTAIN OF LIFE HOME HEALTH CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IESHA PICKENS (OWNER)
(317) 363-9095
Entity
Organization
Contact information
Practice address
8500 AUBURN DR, FORT WORTH, TX 76123-1732
(317) 363-9095
Mailing address
8500 AUBURN DR, FORT WORTH, TX 76123-1732
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
01/28/2013
Last updated
01/28/2013
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