Organization
FOUNTAIN SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ORDIERES FOUNTAIN (DIRECTOR)
(850) 477-3171
Entity
Organization
Contact information
Practice address
7957 PERTH AVE, PENSACOLA, FL 32534-4056
(850) 477-3171
Mailing address
7957 PERTH AVE, PENSACOLA, FL 32534-4056
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
12/22/2007
Last updated
12/22/2007
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