NPIMap

Organization Active NPI

Fountain Therapeutic and Supportive Services LLC

Doing business as MiraLife Health Services

  • Clinical Social Worker
  • Jacksonville, NC
National Provider Identifier
1285959312
Registry record updated Feb 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LC50078852 Issued in DC
Legal business name
FOUNTAIN THERAPEUTIC AND SUPPORTIVE SERVICES LLC
Doing business as
MiraLife Health Services
Practice address
108 Cardiff CT # Cy
Jacksonville, NC 28546-7864
Phone
(301) 437-9666
NPI assigned
Mar 31, 2010
Last updated
Feb 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2015

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

Authorized official

Name
Janny Jinor, LICSWNPI 1689997991
Title
Manager
Phone
(301) 437-9666

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LC50078852 DC Primary

Addresses

Primary practice location

108 Cardiff CT # Cy
Jacksonville, NC 28546-7864

Mailing address

108 Cardiff CT
Jacksonville, NC 28546-7864
Phone (301) 437-9666

Other names 1

  • MiraLife Health Services Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1269993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423612800000",
    "number": "1285959312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 CARDIFF CT",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467864",
            "telephone_number": "301-437-9666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 CARDIFF CT # CY",
            "city": "JACKSONVILLE",
            "state": "NC",
            "postal_code": "285467864",
            "telephone_number": "301-437-9666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN THERAPEUTIC AND SUPPORTIVE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-31",
        "last_updated": "2015-02-11",
        "status": "A",
        "authorized_official_last_name": "JINOR",
        "authorized_official_first_name": "JANNY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "301-437-9666",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "DC",
            "license": "LC50078852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MiraLife Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; 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.