Provider Demographics
NPI:1184438186
Name:FHENIX WEIGHT LOSS FOREVER LLC
Entity type:Organization
Organization Name:FHENIX WEIGHT LOSS FOREVER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MS
Authorized Official - First Name:TISHAMBAY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:281-770-9577
Mailing Address - Street 1:13921 HOLLOW WIND WAY UNIT 101
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-6057
Mailing Address - Country:US
Mailing Address - Phone:281-770-9577
Mailing Address - Fax:765-680-8654
Practice Address - Street 1:6130 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1022
Practice Address - Country:US
Practice Address - Phone:202-715-6626
Practice Address - Fax:765-680-8654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty