FOUNTAIN OF LIFE LLC (NPI# 1396286019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396286019 |
| Entity Type | Organization |
| Organization Name | FOUNTAIN OF LIFE LLC |
| Practice Address |
450 W Broad St Ste 211 Falls Church VA 22046-3318 |
| Practice Telephone | 5712774919 |
| Practice Fax Number | 7032411122 |
| Mailing Telephone | 5712774919 |
| Mailing Fax Number | 7032411122 |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-14 |
| Authorized Official Name | DR. LISA KLEWICKI (CLINICAL PSYCHOLOGIST) |
| Authorized Official Telephone | 5712774919 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103TC0700X |
Psychologist Specialization: Clinical |
0810002980 | VA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710223573 | Fountain of Life LLC | Clinic/Center | 1820 W 43rd St, Houston, TX 77018-3006 | 2012-12-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | FOUNTAIN OF LIFE LLC | 8906 44th Ave W, Mukilteo, WA 98275-3446 |
| Street Address |
450 W BROAD ST STE 211 |
| City | FALLS CHURCH |
| State | VA |
| Zip Code | 22046-3318 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265989503 | Lisa Klewicki | Psychologist | 450 W Broad St Ste 211, Falls Church, VA 22046-3318 | 2016-09-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831735794 | Megan Katherine Hassan | Speech-Language Pathologist | 803 West Broad Street, Suite 100, Falls Church, VA 22046 | 2019-11-25 |
| 1205481173 | Michael William Wirtz | Physical Therapist | 510 South Washington Street, Ste. A, Falls Church, VA 22046 | 2019-08-07 |
| 1629636568 | Meaghan A Souza | Physical Therapist | 510 S Washington Street, Suite A, Falls Church, VA 22046 | 2019-06-05 |
| 1619478963 | Teresa Rosas | Dentist | Blvd Fundadores #8417-21, Tijuana, BAJA CALIFORNIA 22046 | 2018-02-22 |
| 1174022974 | Bio Medical Center | Radiology | 3170 General Ferreira, Colonia Madero Sur, Tijuana, BAJA CALIFORNIA 22046 | 2018-02-07 |
| 1558875385 | M & R Taxi Company, Inc. | Non-emergency Medical Transport (VAN) | 1115 West Broad St., Falls Church, VA 22046 | 2017-12-01 |
| 1356860829 | Neurology | Neuromusculoskeletal Medicine & OMM | 701 W Broad St Ste 214, Falls Church, VA 22046 | 2017-09-15 |
| 1184140501 | Christopher Grivas | Chiropractor | 510 W Annandale Road, Suite 300, Falls Church, VA 22046 | 2017-08-17 |
| 1831562719 | Strategy Anesthesia Virginia, LLC | Anesthesiology | 502 W Broad Street (route 7), Falls Church, VA 22046 | 2015-11-02 |
| 1851762025 | Edward A Stern | Registered Nurse | 201 N Washington Street, C/o Kaiser Permanente, Falls Church, VA 22046 | 2015-10-14 |
| Find all providers in zip 22046 | ||||
| Taxonomy Code | 103TC0700X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| Specialization | Clinical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447891759 | Ericagants.ph.d.pllc | Psychologist | 140 Little Falls St Ste 212, Falls Church, VA 22046-4323 | 2019-10-08 |
| 1346750080 | Michael Krass | Psychologist | 300 N Washington St Ste 302c, Falls Church, VA 22046-3441 | 2017-10-09 |
| 1821533225 | Kayleigh Hale | Psychologist | 300 N Washington St Ste 102g, Falls Church, VA 22046-3441 | 2016-12-21 |
| 1265989503 | Lisa Klewicki | Psychologist | 450 W Broad St Ste 211, Falls Church, VA 22046-3318 | 2016-09-03 |
| 1255799292 | Bronwen Wheeler Rankin | Psychologist | 345 Little Falls St, Falls Church, VA 22046-2636 | 2016-02-05 |
| 1356749766 | Grace Langebeck Guerrero | Psychologist | 2300 Pimmit Dr. #115, Falls Church, VA 22043-2837 | 2014-12-17 |
| 1891131272 | Emily Petersen | Psychologist | 5691 Columbia Pike Ste 200, Falls Church, VA 22041-2888 | 2013-05-13 |
| 1053543157 | Grenell Associates Inc. | Psychologist | 6107g Arlington Blvd, Falls Church, VA 22044-2708 | 2009-08-22 |
| 1245411560 | S. Mark Cross | Psychologist | 109 Park Washington Court, Falls Church, VA 22046-4519 | 2007-11-15 |
| 1902989593 | Gustavo Richard Nava | Psychologist | 5691 Columbia Park, Suite 200, Falls Church, VA 22041 | 2006-10-24 |
| Find all providers in FALLS CHURCH | ||||
| City | FALLS CHURCH |
| Zip Code | 22046 |
Please comment or provide details below to improve the information on FOUNTAIN OF LIFE LLC.
| 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.