Organization
FOUNTAIN OF YOUTH, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE FOUTCH (SITE DIRECTOR)
(479) 484-7782
Entity
Organization
Contact information
Practice address
2409 S 56TH ST, SUITE 121, FORT SMITH, AR 72903-3753
(479) 484-7782
(479) 484-7951
Mailing address
2409 S 56TH ST, SUITE 121, FORT SMITH, AR 72903-3753
(479) 484-7782
(479) 484-7951
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
105
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
165464755
—
AR
Enumeration date
04/22/2008
Last updated
09/05/2012
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