Provider Demographics
NPI:1336960749
Name:FOUNTAINS OF RICHMOND, LLC
Entity type:Organization
Organization Name:FOUNTAINS OF RICHMOND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-560-7080
Mailing Address - Street 1:7103 S PEEK RD STE 300B
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-3770
Mailing Address - Country:US
Mailing Address - Phone:346-560-7080
Mailing Address - Fax:346-560-7081
Practice Address - Street 1:7103 S PEEK RD STE 300B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-3770
Practice Address - Country:US
Practice Address - Phone:346-560-7080
Practice Address - Fax:346-560-7081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-18
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center