NPI 1225202179

Fountain of Youth, INC

Organisation Voluntary or Charitable Agency Fort Smith, AR

Practice location

Address: 2409 S 56th St Suite 121, Fort Smith, AR 72903-3753
Phone: (479) 484-7782
Fax: (479) 484-7951

Authorised official

Name: Michelle Foutch
Title: Site Director
Phone: (479) 484-7782

Registered specialties

Voluntary or Charitable Agency Primary

Agencies Taxonomy 251V00000X Licence 105 (AR)

Other Voluntary or Charitable providers in Arkansas →

Registry record

NPI: 1225202179
Entity type: Organization
NPI issued: 22 Apr 2008
Record last updated: 5 Sep 2012

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.