Provider Demographics
NPI:1093436842
Name:FOUNTAINS OF ASHEVILLE, LLC
Entity Type:Organization
Organization Name:FOUNTAINS OF ASHEVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
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:828-579-3640
Mailing Address - Street 1:70 PEACHTREE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3391
Mailing Address - Country:US
Mailing Address - Phone:828-579-3640
Mailing Address - Fax:828-579-3641
Practice Address - Street 1:70 PEACHTREE RD STE 120
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3391
Practice Address - Country:US
Practice Address - Phone:828-579-3640
Practice Address - Fax:828-579-3641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy