Organization
FOUNTAIN OF CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI N CLARK (OWNER/ADMINISTRATOR)
(313) 969-5128
Entity
Organization
Contact information
Practice address
29225 HERITAGE CT, SOUTHFIELD, MI 48076-1743
(313) 969-5128
(248) 785-3623
Mailing address
29225 HERITAGE CT, SOUTHFIELD, MI 48076-1743
(313) 969-5128
(248) 785-3623
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
Other
Enumeration date
05/10/2011
Last updated
09/12/2014
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