Fountain Of Youth, Inc

LBN: Fountain Of Youth, Inc
Fountain Of Youth, Inc is an health care organization with primary practice located at 2409 S 56Th St Suite 121, Fort Smith AR 72903-3753. The organization recently has only one registered license in Agencies / Voluntary or Charitable, which is considered as the primary health care specialty. Fountain Of Youth, Inc can be contacted via phone (479) 484-7782, or through Foutch, Michelle via phone (479) 484-7782.

Contact Information

Primary practice address
2409 S 56Th St Suite 121 Fort Smith AR 72903-3753
Phone: (479) 484-7782
Fax: (479) 484-7951
Website:
Map and Directions
Authorized official contact:
Name: Foutch, Michelle
Phone: (479) 484-7782

Health care specialties

SpecialtyCodeLicense #State
Agencies / Voluntary or Charitable 251V00000X 105 Arkansas

Profile Details

NPI number 1225202179
LBN Legal business name Fountain Of Youth, Inc
DBA Doing business as
Authorized official Foutch, Michelle
Entity Organization
Organization subpart 1 No
Enumeration date Apr 22nd, 2008
Last updated Sep 5th, 2012 - about 13 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225202179 NPPES
Arkansas MEDICAID 165464755

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