Organization · NPI-2

Fountain Life Dallas, LLC

Clinic/Center · The Colony, TX

NPI number1336829514
StatusActive
Last updated in NPPESJul 21, 2023

Details

NPI
1336829514
Entity type
Organization (NPI-2)
Legal business name
Fountain Life Dallas, LLC
Organization subpart
No
Enumeration date
Jul 21, 2023
Certification date
Jul 21, 2023
Last updated
Jul 21, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261Q00000X Clinic/Center––Yes

Other names

  • Fountain Life Orlando, Lllc (Doing Business As)

Practice location

5762 Grandscape Blvd Ste 115
The Colony, TX 75056-6782

Phone 469-669-0336

Mailing address

5762 Grandscape Blvd Ste 115
The Colony, TX 75056-6782

Phone 469-669-0336

Authorized official

Barbara Woo
Director Of Clinical Operations
9178108672

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Clinic/Center providers in The Colony, TX