Organization
HEALING FOUNTAIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALI AL BAYATI (OWNER)
(480) 452-9149
Entity
Organization
Contact information
Practice address
58 N COUNTRY CLUB DR STE 107, MESA, AZ 85201-6502
(480) 452-9149
Mailing address
58 N COUNTRY CLUB DR STE 107, MESA, AZ 85201-6502
(480) 452-9149
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC12317
AZDHS
AZ
Enumeration date
03/02/2023
Last updated
03/02/2023
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