Fountain of Life Hospice

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

FOUNTAIN OF LIFE HOSPICE

Practice address

818 N Mountain Ave Ste 203B
Upland, CA 91786-4165

Phone

(951) 267-7495

Fax

(951) 267-7689

NPI assigned

Jan 6, 2021

Organization subpart

No

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

Authorized official

Name

Archibon Lamaria

Title

Ceo

Phone

(951) 267-7495

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1609891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609891200000",
    "number": "1700474632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "818 N MOUNTAIN AVE STE 203B",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864165",
            "telephone_number": "951-267-7495",
            "fax_number": "951-267-7689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 N MOUNTAIN AVE STE 203B",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864165",
            "telephone_number": "951-267-7495",
            "fax_number": "951-267-7689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN OF LIFE HOSPICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-06",
        "last_updated": "2021-01-06",
        "certification_date": "2021-01-06",
        "status": "A",
        "authorized_official_last_name": "LAMARIA",
        "authorized_official_first_name": "ARCHIBON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "951-267-7495"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Forgione
• Richard Edward Fort, MFT
• Richard Patrick Foss II, CMPSS
• Trevor Eugene Foster Jr, AMFT
• Fouad D Tawadrous MD Inc
• Sean C Fox, D.C.
• Steven Douglas Fraker, DDS
• Rowena Francisco, PT
• David Frandsen, NP
• Frank D. Utzurrum, MD Inc

• Community Based Hospice Care Agency in Upland, CA
• Providers in Upland, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; 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.