FOUNTAIN OF LIFE BEHAVIORAL HEALTH COUNSELING & WELLNESS CTR. (NPI# 1033761325) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033761325 |
| Entity Type | Organization |
| Organization Name | FOUNTAIN OF LIFE BEHAVIORAL HEALTH COUNSELING & WELLNESS CTR. |
| Other Organization Name | FOUNTAIN OF LIFE BEHAVIORAL HEALTH COUNSELING & WELLNESS CTR. |
| Practice Address |
3704 Fairview Ave Baltimore MD 21216-1313 |
| Practice Telephone | 4435588933 |
| Practice Fax Number | 4439659523 |
| Mailing Telephone | 4435588933 |
| Mailing Fax Number | 4439659523 |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2019-07-31 |
| Authorized Official Name | DR. PATRICIA ANN HARRIOTT (CEO/DIRECTOR) |
| Authorized Official Telephone | 4435588933 |
| Authorized Official Credential | PHD,LCPC,GPP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 07162019328804 | 05 |
| Other Name | Type Code |
|---|---|
| Fountain of Life Behavioral Health Counseling & Wellness Ctr. | Former Legal Business Name - Organization |
| Street Address |
3704 FAIRVIEW AVE |
| City | BALTIMORE |
| State | MD |
| Zip Code | 21216-1313 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083279343 | Matanmi Olusesan Kuforiji | Social Worker | 2300 Garrison Boulevard Suite 101, Baltimore, MD 21216 | 2019-05-02 |
| 1003389602 | Michelle Antoinette Goines | Social Worker | 1522 N Ellamont St, Baltimore, MD 21216 | 2019-01-07 |
| 1780178764 | Lifespring Laboratories | Clinical Medical Laboratory | 2200 Garrison Blvd Ste 3013, Baltimore, MD 21216 | 2018-06-21 |
| 1467980896 | Patricia Ann Harriott | Counselor | 3312alto Rd., Baltimore, MD 21216 | 2017-05-30 |
| 1538549209 | Baltimore Podiatry Group, Dr. Benjamin Kleinman, P.a. | Durable Medical Equipment & Medical Supplies | 2300 Garrison Blvd., Suite 105, Baltimore, MD 21216 | 2015-06-08 |
| 1649461500 | Issac Corrette Evans Jr. | Adult Companion | 2810 Harlem Ave, Baltimore, MD 21216 | 2007-08-06 |
| 1396824959 | Linda S Miles | Dentist | 4155 Patterson Ave, Baltimore, MD 21216 | 2006-11-03 |
| 1902913197 | Miriam W Ingram | Nurse Practitioner | 3102 N Hilton Street, Baltimore, MD 21216 | 2006-08-24 |
| 1326065905 | Linda P Weisburger | Nurse Practitioner | 2001 N Warwick Ave, Baltimore, MD 21216 | 2006-07-17 |
| 1972502680 | Shavon Trenice Darden | Nurse Practitioner | 2601 W North Ave, Hhsb Suite 131, Baltimore, MD 21216 | 2005-07-15 |
| Find all providers in zip 21216 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942808050 | Powell Recovery Center, Inc. | Substance Abuse Rehabilitation Facility | 10 S Broadway, Baltimore, MD 21231-1775 | 2020-10-12 |
| 1396343414 | Powell Recovery Center, Inc. | Substance Abuse Rehabilitation Facility | 15 S Broadway, Baltimore, MD 21231-1714 | 2020-10-12 |
| 1457968984 | Powell Recovery Center | Substance Abuse Rehabilitation Facility | 22 S Broadway, Baltimore, MD 21231-1711 | 2020-09-29 |
| 1356956676 | The Elysian Fields Optimum Wellness and Mental Health Group, LLC | Substance Abuse Rehabilitation Facility | 2901 Erdman Ave, Baltimore, MD 21213-1139 | 2020-09-14 |
| 1134731284 | Serenity Keepers of Maryland LLC | Substance Abuse Rehabilitation Facility | 3645 Cottage Ave, Baltimore, MD 21215-7725 | 2020-08-20 |
| 1447875216 | Unlimited Bounds Human Services LLC | Substance Abuse Rehabilitation Facility | 504 Beaumont Ave, Baltimore, MD 21212-4310 | 2020-06-08 |
| 1417577966 | Royal Minds Inc | Substance Abuse Rehabilitation Facility | 928 W Franklin St, Baltimore, MD 21223-1337 | 2020-04-24 |
| 1912527722 | Royal Minds Inc | Substance Abuse Rehabilitation Facility | 533 Chateau Ave, Baltimore, MD 21212-4306 | 2020-04-22 |
| 1841829892 | Cmds Residential | Substance Abuse Rehabilitation Facility | 15 S Fulton Ave, Baltimore, MD 21223-2306 | 2020-04-02 |
| 1306472964 | Created for Greater Health Systems | Substance Abuse Rehabilitation Facility | 1508 N Caroline St, Baltimore, MD 21213-2804 | 2020-03-16 |
| Find all providers in BALTIMORE | ||||
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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.