Healing Fountain LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

HEALING FOUNTAIN LLC

Practice address

58 N Country Club Dr Ste 107
Mesa, AZ 85201-6502

Phone

(480) 452-9149

NPI assigned

Mar 2, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ali Al Bayati

Title

Owner

Phone

(480) 452-9149

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1677715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677715200000",
    "number": "1467151027",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 N COUNTRY CLUB DR STE 107",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852016502",
            "telephone_number": "480-452-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 N COUNTRY CLUB DR STE 107",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852016502",
            "telephone_number": "480-452-9149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALING FOUNTAIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-02",
        "last_updated": "2023-03-02",
        "certification_date": "2023-03-02",
        "status": "A",
        "authorized_official_last_name": "AL BAYATI",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "480-452-9149"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZDHS",
            "identifier": "OTC12317",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Community/Behavioral Health Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.