Fountain of Life Healthcare PC.

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

FOUNTAIN OF LIFE HEALTHCARE PC.

Practice address

7375 Executive PL
Lanham, MD 20706-2278

Phone

(301) 806-7473

Fax

(410) 988-2868

NPI assigned

Mar 22, 2022

Last updated

Jul 13, 2023By 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

Chidi Roovelt NwachukwuNPI 1578031977

Title

Provider

Phone

(410) 777-5292

Specialties & licenses 1

Addresses

Locations

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.

• Chidi Roovelt Nwachukwu, CRNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Lanham, MD
  • NPI 1578031977
  Authorized official Same address or phone

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

{
    "created_epoch": "1647907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689206400000",
    "number": "1396494878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7375 EXECUTIVE PL",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207062278",
            "telephone_number": "301-806-7473",
            "fax_number": "410-988-2868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7375 EXECUTIVE PL",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207062278",
            "telephone_number": "301-806-7473",
            "fax_number": "410-988-2868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN OF LIFE HEALTHCARE PC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-22",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A",
        "authorized_official_last_name": "NWACHUKWU",
        "authorized_official_first_name": "CHIDI",
        "authorized_official_middle_name": "ROOVELT",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "410-777-5292"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian Dobgima Fotachwi
• Mathias Fotachwi
• Paulette Valerie Fouedjio
• Negar Fouladi Nashta, MD
• Fountain Behavioral Health Services Inc
• Rosine Fouodji
• Jan Dixon Foushee, MD
• Augustina O Fox
• Doreen Foy, PHARMD
• Denise France-Steele, LME

• Mental Health Clinic/Center (Including Community Mental Health Center) in Lanham, MD
• Providers in Lanham, MD by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2023; 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.