FOUNTAIN ADULT HOME CARE, LLC (NPI# 1295191450) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295191450 |
| Entity Type | Organization |
| Organization Name | FOUNTAIN ADULT HOME CARE, LLC |
| Practice Address |
303 William Walston Lane Tarboro NC 27886 |
| Mailing Address |
303 William Walston Lane Tarboro NC 27886-8587 |
| Practice Telephone | 2526414388 |
| Practice Fax Number | 2526416412 |
| Mailing Telephone | 2526414388 |
| Mailing Fax Number | 2526416412 |
| Enumeration Date | 2016-01-04 |
| Last Update Date | 2016-05-10 |
| Authorized Official Name | MRS. SHIRLEY WALSTON MCNEIL (OWNER/ADMINISTRATOR) |
| Authorized Official Telephone | 2526414388 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
FCL033012 | NC | Nursing & Custodial Care Facilities |
| Street Address |
303 WILLIAM WALSTON LANE |
| City | TARBORO |
| State | NC |
| Zip Code | 27886 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336781566 | Fountain Transportation | Non-emergency Medical Transport (VAN) | 350 William Walston Lane, Tarboro, NC 27886 | 2019-10-09 |
| 1942737481 | Jude Ude | Pharmacist | 1519 Man Street, Tarboro, NC 27886 | 2017-05-15 |
| 1487197406 | Fms Ena Home, LLC | Clinic/Center | 122 Hospital Drive, Tarboro, NC 27886 | 2016-11-22 |
| 1033464805 | Tiffany Chapman Barber | Pharmacist | 1519 N Main Street, Tarboro, NC 27886 | 2012-07-18 |
| 1891085247 | Illumi-nation Care Home | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 7806 Hwy 42 East, Tarboro, NC 27886 | 2011-04-19 |
| 1376842187 | Hiren C Patel | Pharmacist | 1600 North Main St., Tarboro, NC 27886 | 2011-03-18 |
| 1407976590 | Edgecombe Chiropractic Inc | Chiropractor | 1801 Main Street, Tarboro, NC 27886 | 2007-03-30 |
| 1265567762 | Rinson A Weathers | Personal Emergency Response Attendant | 111 Hospital Drive, Tarboro, NC 27886 | 2007-02-23 |
| 1780758961 | George Thomas Ward | Dentist | 112 W St John Street, Tarboro, NC 27886 | 2006-11-20 |
| 1720166838 | Tarboro Care LLC | Skilled Nursing Facility | 911 Western Blvd, Tarboro, NC 27886 | 2006-11-02 |
| Find all providers in zip 27886 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770529141 | Tar River Ltc Group, LLC | Custodial Care Facility | 3210 Western Blvd, Tarboro, NC 27886-1828 | 2006-06-22 |
| 1063619724 | Leisure Home Life, Inc. | Custodial Care Facility | 800 E Saint John St, Tarboro, NC 27886-4544 | 2007-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578162061 | Lewis E Williams | Custodial Care Facility | 1640 Bridgedale Dr, Rocky Mount, NC 27803-1604 | 2020-10-26 |
| 1861008583 | Arbor Landing At Hampstead LLC | Custodial Care Facility | 13937 Us Highway 17, Hampstead, NC 28443-4041 | 2020-09-17 |
| 1124645544 | Charlotte Sp Senior Housing Opco, LLC | Custodial Care Facility | 6041 Piedmont Row Drive, Charlotte, NC 28208 | 2020-07-01 |
| 1740804111 | Happy Hearts Group Home | Custodial Care Facility | 6255 Burlington Rd, Gibsonville, NC 27249-8783 | 2020-06-02 |
| 1730703422 | Graham 4 Enterprises | Custodial Care Facility | 3006 W Sedgefield Dr, Greensboro, NC 27407-7313 | 2020-05-29 |
| 1477177111 | C&s Adult Care LLC, Dba Deal Care Inn | Custodial Care Facility | 1075 Deal Rd, Mooresville, NC 28115-6719 | 2020-05-28 |
| 1114554516 | Cassandra Davis | Custodial Care Facility | 131 Huntington Rd, Louisburg, NC 27549 | 2020-03-25 |
| 1356975767 | Cornerstone Community Service | Custodial Care Facility | 2220 Southgate St, Durham, NC 27703-2102 | 2020-02-24 |
| 1477184653 | Rose Vista Assisted Living, LLC | Custodial Care Facility | 2130 Rose Vista Rd, Kinston, NC 28504-8230 | 2020-01-28 |
| 1104456011 | Regina Williams | Custodial Care Facility | 511 Tansy Drive, Charlotte, NC 28214 | 2020-01-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.