Fountain of Health Home Health Agency LLC

Primary specialty

Nursing Care AgencyTaxonomy code 251J00000X

Legal business name

FOUNTAIN OF HEALTH HOME HEALTH AGENCY LLC

Practice address

5875 N Lincoln Ave Ste 243
Chicago, IL 60659-4668

Phone

(847) 859-6217

Fax

(847) 859-6227

NPI assigned

Jan 16, 2021

Last updated

Nov 4, 2024By 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

Olugbenga Ayeni

Title

Administrator

Phone

(773) 428-2259

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1610755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730678400000",
    "number": "1962091686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 BRUMMEL ST",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602023706",
            "telephone_number": "847-859-6217",
            "fax_number": "847-859-6227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5875 N LINCOLN AVE STE 243",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606594668",
            "telephone_number": "847-859-6217",
            "fax_number": "847-859-6227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN OF HEALTH HOME HEALTH AGENCY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-16",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A",
        "authorized_official_last_name": "AYENI",
        "authorized_official_first_name": "OLUGBENGA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "773-428-2259"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; 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.