Fountain of Youth, INC
NPI #1225202179 in Fort Smith, Arkansas
Provider Information
- NPI Number
- 1225202179
- Entity Type
- Organization
- Organization Name
- Fountain of Youth, INC
- Primary Specialty
- Voluntary or Charitable
- Enumeration Date
- Apr 22, 2008
- Last Updated
- Sep 5, 2012
Practice Location
- Address
- 2409 S 56TH ST
- Address 2
- SUITE 121
- City
- Fort Smith
- State
- Arkansas
- ZIP Code
- 72903-3753
- Phone
- (479) 484-7782
Authorized Official
- Name
- MICHELLE FOUTCH
- Title
- SITE DIRECTOR
- Phone
- (479) 484-7782
Specialties & Taxonomy Codes
| Specialty |
|---|
| Voluntary or Charitable |
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