Fountain Hospice, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

FOUNTAIN HOSPICE, INC.

Practice address

6308 Woodman Ave Ste 214
Van Nuys, CA 91401-2395

Phone

(818) 839-8807

NPI assigned

Jul 30, 2020

Organization subpart

No

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

Authorized official

Name

Nuritsa Martinyan

Title

Ceo

Phone

(818) 839-8807

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN B21788

Legal name

FOUNTAIN HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 13, 2021

Last certification

Oct 13, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Jul 2, 2020 in CA

Enrollment address

13523 Ventura Blvd
Sherman Oaks, CA 91423-3801

Listed as

Fountain Hospice, Inc.CCN B21788

Ownership

For-Profit

Certified

Oct 13, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Mayur C Patel, MD

  • Pulmonary Disease Physician
  • Burbank, CA
  • NPI 1669451571

  Contracted Managing Employee

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Natalie Nazaretian

  • Family Nurse Practitioner
  • Sherman Oaks, CA
  • NPI 1295454114
  NPD (past)

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Berj Dermendjian, D.O

  • Internal Medicine Physician
  • Sherman Oaks, CA
  • NPI 1225488851

  Hospice

  Care Compare affiliation
• Mayur C Patel, MD

  • Pulmonary Disease Physician
  • Burbank, CA
  • NPI 1669451571

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1720697196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6308 WOODMAN AVE STE 214",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012395",
            "telephone_number": "818-839-8807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6308 WOODMAN AVE STE 214",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012395",
            "telephone_number": "818-839-8807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "MARTINYAN",
        "authorized_official_first_name": "NURITSA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-839-8807"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Robert Foss
• Desiree Fossett
• Ashley Elizabeth Foster, RN
• Jodi-Ann Nicole Foster, PT, DPT
• Founders Healthcare, LLC.
• Fountain of Hope Hospice
• Marian A. Fowler, PAC
• Beth Lori Fox, MFTI
• Stephanie Nicole Fox
• Milana Fradkin

• All providers in Van Nuys, CA
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.