Fountain of Life Wellness Center

Primary specialty

Voluntary or Charitable AgencyTaxonomy code 251V00000X

License

602786502 Issued in WA

Legal business name

FOUNTAIN OF LIFE WELLNESS CENTER

Doing business as

Fountain of Life Center

Practice address

1314 72ND St E
Tacoma, WA 98404-3343

Phone

(253) 380-5263

NPI assigned

Jun 27, 2010

Organization subpart

No

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

Authorized official

Name

Brenda Milewski

Title

Executive Director

Phone

(253) 380-5263

Specialties & licenses 1

Addresses

Other names 1

• Fountain of Life Center Doing business as

Locations

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

{
    "created_epoch": "1277596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277596800000",
    "number": "1558672329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14010 68TH AVE E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983738706",
            "telephone_number": "253-380-5263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1314 72ND ST E",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984043343",
            "telephone_number": "253-380-5263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN OF LIFE WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-27",
        "last_updated": "2010-06-27",
        "status": "A",
        "authorized_official_last_name": "MILEWSKI",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "253-380-5263"
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "WA",
            "license": "602786502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountain of Life Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tanya Mae Foster, ARNP,CNM
• Terri Guesman Foster, PHARMD
• Alisha Marie Fouch, LPN
• Foundation for Multicultural Solutions/ El Camino Program
• Foundational Roots Therapy and Consulting
• Andreya Fountain, SUDPT
• Naomi Janeva Fountain
• Jackie Michelle Fournier, MSW, LICSW
• Alyssa Fouts
• Kelli Marie Fouts

• Voluntary or Charitable Agency in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Voluntary or Charitable Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2010; 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.