Organization
FOUNTAIN OF HEALTH HOME HEALTH AGENCY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
OLUGBENGA AYENI (ADMINISTRATOR)
(773) 428-2259
Entity
Organization
Contact information
Practice address
5875 N LINCOLN AVE STE 243, CHICAGO, IL 60659-4668
(847) 859-6217
(847) 859-6227
Mailing address
1420 BRUMMEL ST, EVANSTON, IL 60202-3706
(847) 859-6217
(847) 859-6227
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
Primary
—
—
Other
Enumeration date
01/16/2021
Last updated
11/04/2024
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