FOUNTAIN OF YOUTH INC NPI 1225202179

NPI Information

NPI: 1225202179
Provider Name: FOUNTAIN OF YOUTH, INC
Classification: Voluntary or Charitable - 251V00000X
Entity Type: Organization
Address:
2409 S 56TH ST
SUITE 121
FORT SMITH, AR
ZIP 72903
Phone: (479) 484-7782
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FOUNTAIN OF YOUTH, INC is a voluntary or charitable in Fort Smith, AR. FOUNTAIN OF YOUTH, INC NPI is 1225202179. The provider is registered as an organization entity type.

The provider's business location address is:

2409 S 56TH ST
SUITE 121
FORT SMITH, AR
ZIP 72903-753
Phone: (479) 484-7782
Fax: (479) 484-7951

The provider's authorized official is Michelle Foutch .
The authorized official title is Site Director and has the following contact phone number (479) 484-7782.

The enumeration date for this NPI number is 4/22/2008 and was last updated on 9/5/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251V00000X	Voluntary or Charitable		105	ARKANSAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	165464755	MEDICAID	ARKANSAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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