Life Fountain Health Care, Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

LIFE FOUNTAIN HEALTH CARE, INC

Practice address

1115 New Halls Ferry Rd
202
Saint Louis, MO 63033

Phone

(314) 830-3840

Fax

(314) 830-3820

NPI assigned

May 23, 2006

Last updated

Apr 5, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Adegbola Adejisola Adegoke

Title

Owner

Phone

(314) 454-6865

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043265887. Details of each certification follow.

• CCN 267611 Home health agency · Active · Details

Home health agency certification: CCN 267611

Legal name

LIFE FOUNTAIN HEALTH CARE, INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Dec 11, 2007

Last certification

Oct 23, 2019

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Feb 17, 2006 in MO

Enrollment address

2870 Netherton Dr
# B
Saint Louis, MO 63136-4649

Listed as

Life Fountain Health Care, Inc.CCN 267611 · All quality measures

Overall star rating

2.5 of 5

Ownership

Proprietary

Certified

Dec 11, 2007

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Zahirul Haque, MD

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1578536546

  Home health agency

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459814400000",
    "number": "1043265887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11115 NEW HALLS FERRY RD",
            "address_2": "202",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630337613",
            "telephone_number": "314-830-3840",
            "fax_number": "314-830-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 NEW HALLS FERRY RD",
            "address_2": "202",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "63033",
            "telephone_number": "314-830-3840",
            "fax_number": "314-830-3820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE FOUNTAIN HEALTH CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-23",
        "last_updated": "2016-04-05",
        "status": "A",
        "authorized_official_last_name": "ADEGOKE",
        "authorized_official_first_name": "ADEGBOLA",
        "authorized_official_middle_name": "ADEJISOLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "314-454-6865",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN NUMBER",
            "identifier": "267611",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julia Kyungwon Lieu
• Life Aid Medical Supplies Inc
• Life Connections Home Solutions LLC
• Life Development Support Centers
• Life Forward Home Health Services LLC
• Life Line Surgical Services LLC
• Life Links Home Healthcare Services, Inc
• Life Skills Foundation
• Life Skills Foundation
• Life Skills Foundation, Inc

• Home Health Agency in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Home Health Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.