Fountain of Youth LLC Residential Care
NPI #1306608195 in Mount Olive, North Carolina
Provider Information
- NPI Number
- 1306608195
- Entity Type
- Organization
- Organization Name
- Fountain of Youth LLC Residential Care
- Primary Specialty
- Custodial Care Facility - Adult Care Home
- Enumeration Date
- Jan 26, 2024
- Last Updated
- Jan 13, 2025
Practice Location
- Address
- 1116 S CHURCH ST
- City
- Mount Olive
- State
- North Carolina
- ZIP Code
- 28365-2504
- Phone
- (919) 299-4539
Authorized Official
- Name
- SADIO SYKES
- Title
- ADMINISTER
- Phone
- (571) 484-4472
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community/Behavioral Health |
| Private Vehicle |
| Custodial Care Facility - Adult Care Home — Adult Care Home |
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