MEDICARE: FOUNTAIN OF HOPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1598454001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNTAIN OF HOPE

Provider Business Mailing Address
First Line	:	4444 W NORTHERN AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-1683
Country	:	US
Telephone Number	:	623-594-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 W NORTHERN AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-1683
Country	:	US
Telephone Number	:	623-594-7100
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	LORRI MCNEAL
Credential	:	LMFT/DR.
Telephone Number	:	909-919-8134

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	05/02/2023

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Directions to “FOUNTAIN OF HOPE ” Practice Location

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