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FOUNTAIN LIFE DALLAS, LLC
NPI 1336829514
Clinic/Center in The Colony, TX

Active since July 21, 2023CLIA 10D2274017 · Waiver
5762 GRANDSCAPE BLVD STE 115, THE COLONY, TX 75056(469) 669-0336 Get Directions Write a Review

NPPES record last updated: July 21, 2023. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Fountain Life Dallas, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FOUNTAIN LIFE DALLAS, LLC (NPI 1336829514), doing business as Fountain Life Orlando, Lllc, is a healthcare organization registered as a clinic/center in The Colony, Texas and active in the NPI registry since July 2023. The organization holds a CLIA Waiver certificate valid through December 21, 2026 and lists Barbara Woo, Director Of Clinical Operations, as its authorized official.

NPPES Registry Identity

NPI1336829514
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameFOUNTAIN LIFE DALLAS, LLC
Location Address5762 GRANDSCAPE BLVD STE 115The Colony, TX 75056-6782
Mailing Address5762 Grandscape Blvd Ste 115The Colony, TX 75056-6782 · (469) 669-0336
Phone(469) 669-0336
Organization SubpartNo
Authorized OfficialBarbara WooDirector Of Clinical Operations · (917) 810-8672
Enumeration DateJuly 21, 2023
NPPES CertifiedJuly 21, 2023
✔ NPI 1336829514 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition

A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

5762 GRANDSCAPE BLVD STE 115, The Colony, TX 75056
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Other Names 1

Doing Business AsFountain Life Orlando, Lllc

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2274017

Fountain Life Orlando LLC · Orlando, FL
Active · expires Dec 21, 2026
CLIA Number10D2274017
Laboratory TypePhysician Office
Certificate Effective DateDecember 22, 2024
Certificate Expiration DateDecember 21, 2026
Laboratory DirectorJimmy D. Bowen
Laboratory Phone(917) 810-8672
Laboratory LocationFountain Life Orlando LLC6424 Alexandra Louise Drive Suite 120, Orlando, FL 32827
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. AMRIEN GHOUSE D.O
Family Medicine
5762 GRANDSCAPE BLVD STE 115
THE COLONY, TX 75056
Denton County (469) 647-9344
DALLAS NICOLE HAKES PA-C
Physician Assistant
5762 GRANDSCAPE BLVD STE 115
THE COLONY, TX 75056
Denton County (469) 647-9344

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fountain Life Dallas, LLC's NPI number?

The NPI number for Fountain Life Dallas, LLC is 1336829514. It was assigned to this organization in the NPPES registry on July 21, 2023.

Where is Fountain Life Dallas, LLC located?

Fountain Life Dallas, LLC is located at 5762 Grandscape Blvd Ste 115, The Colony, TX 75056. The listed phone number is (469) 669-0336.

What is Fountain Life Dallas, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Does Fountain Life Dallas, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2274017) is associated with this NPI, valid through December 21, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Fountain Life Dallas, LLC was last updated on July 21, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.