Provider Demographics
NPI:1871145532
Name:SPARKLING FOUNTAIN OF LOVE ADULT CARE HOMES
Entity type:Organization
Organization Name:SPARKLING FOUNTAIN OF LOVE ADULT CARE HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GITOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-766-8526
Mailing Address - Street 1:8525 SWITZER ROAD
Mailing Address - Street 2:
Mailing Address - City:OVERLANDPARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214
Mailing Address - Country:US
Mailing Address - Phone:913-766-8526
Mailing Address - Fax:913-273-0242
Practice Address - Street 1:8525 SWITZER ROAD
Practice Address - Street 2:
Practice Address - City:OVERLANDPARK
Practice Address - State:KS
Practice Address - Zip Code:66214
Practice Address - Country:US
Practice Address - Phone:913-766-8526
Practice Address - Fax:913-273-0242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No174200000XOther Service ProvidersMeals
No251J00000XAgenciesNursing Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No385H00000XRespite Care FacilityRespite Care