Fountain of Youth Activity Center, LLC

NPI #1134797715 in Raytown, Missouri

Provider Information

NPI Number: 1134797715
Entity Type: Organization
Organization Name: Fountain of Youth Activity Center, LLC
Primary Specialty: Program of All-Inclusive Care for the Elderly (PACE) Provider Organization
Enumeration Date: Jun 11, 2021
Last Updated: Jun 11, 2021

Practice Location

Address: 8801 E 63RD ST STE 101
City: Raytown
State: Missouri
ZIP Code: 64133-4865
Phone: (816) 886-0442

Authorized Official

Name: JOHN PARKER
Title: EXECUTIVE DIRECTOR
Phone: (816) 503-9865

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Non-emergency Medical Transport (VAN)	343900000X
Program of All-Inclusive Care for the Elderly (PACE) Provider Organization	251T00000X	Primary

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