Fountain Assissted Living Center LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

FOUNTAIN ASSISSTED LIVING CENTER LLC

Practice address

2260 E Brown Road
Mesa, AZ 85213-5224

Phone

(480) 299-3310

NPI assigned

Dec 9, 2020

Organization subpart

No

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

Authorized official

Name

Mrs. Kirstin Lundahl

Title

Owner/Business Manager

Phone

(480) 206-4241

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739491200000",
    "number": "1215533757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3048 E BASELINE RD",
            "address_2": "STE 108",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "85204",
            "telephone_number": "480-206-4241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2260 E BROWN ROAD",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852135224",
            "telephone_number": "480-299-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN ASSISSTED LIVING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-09",
        "last_updated": "2025-02-14",
        "certification_date": "2020-12-08",
        "status": "A",
        "authorized_official_last_name": "LUNDAHL",
        "authorized_official_first_name": "KIRSTIN",
        "authorized_official_title_or_position": "OWNER/BUSINESS MANAGER",
        "authorized_official_telephone_number": "480-206-4241",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103616",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.