Organization
FOUNTAIN OF YOUTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT ALEXANDER (PRESIDENT)
(718) 667-8521
Entity
Organization
Contact information
Practice address
26 DUMONT AVE, STATEN ISLAND, NY 10305-1450
(718) 667-8510
(718) 667-8884
Mailing address
26 DUMONT AVE, STATEN ISLAND, NY 10305-1450
(718) 667-8510
(718) 667-8884
Taxonomy
Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
Other
Enumeration date
05/01/2014
Last updated
05/01/2014
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