Provider Demographics
NPI:1598454001
Name:FOUNTAIN OF HOPE
Entity type:Organization
Organization Name:FOUNTAIN OF HOPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LORRI
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEAL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT/DR
Authorized Official - Phone:909-919-8134
Mailing Address - Street 1:4444 W NORTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85301-1683
Mailing Address - Country:US
Mailing Address - Phone:623-594-7100
Mailing Address - Fax:
Practice Address - Street 1:4444 W NORTHERN AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-1683
Practice Address - Country:US
Practice Address - Phone:623-594-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty