NPI 1134797715

Fountain of Youth Activity Center, LLC

Organisation PACE Provider Organization Raytown, MO

Practice location

Address: 8801 E 63rd St STE 101, Raytown, MO 64133-4865
Phone: (816) 886-0442
Fax: (816) 503-9408

Authorised official

Name: John Parker
Title: Executive Director
Phone: (816) 503-9865

Registered specialties (2)

PACE Provider Organization Primary

Agencies Taxonomy 251T00000X

Other Program of All-Inclusive Care for the Elderly (PACE) Provider Organization providers in Missouri →

Non-emergency Medical Transport (VAN)

Transportation Services Taxonomy 343900000X

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Registry record

NPI: 1134797715
Entity type: Organization
NPI issued: 11 Jun 2021
Record last updated: 11 Jun 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.