Fountain Adult Home Care, LLC

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

FCL033012 Issued in NC

Legal business name

FOUNTAIN ADULT HOME CARE, LLC

Practice address

303 William Walston Lane
Tarboro, NC 27886

Phone

(252) 641-4388

Fax

(252) 641-6412

NPI assigned

Jan 4, 2016

Last updated

May 10, 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

Mrs. Shirley Walston McNeil

Title

Owner/Administrator

Phone

(252) 641-4388

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1451865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1462838400000",
    "number": "1295191450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 WILLIAM WALSTON LANE",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "278868587",
            "telephone_number": "252-641-4388",
            "fax_number": "252-641-6412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 WILLIAM WALSTON LANE",
            "city": "TARBORO",
            "state": "NC",
            "postal_code": "27886",
            "telephone_number": "252-641-4388",
            "fax_number": "252-641-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN ADULT HOME CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-04",
        "last_updated": "2016-05-10",
        "status": "A",
        "authorized_official_last_name": "MCNEIL",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "WALSTON",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "252-641-4388",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NC",
            "license": "FCL033012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• First Class Transit Inc
• Shaun Fitzpatrick, FNP
• FMS Ena Home, LLC (Edgecombe Home Dialysis)
• Matthew Fornes, MS, CCC-SLP
• Meaghan Foster
• Fountain Transportation
• Lavone Freeman
• Paula Elizabeth Fulford, PT, DPT
• Karen Suzanne Gaither, PTA
• Thomas John Galisin, PA-C

• Adult Care Home Facility in Tarboro, NC
• Providers in Tarboro, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; 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.