Organization
FOUNTAIN OF YOUTH LLC RESIDENTIAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SADIO SYKES (ADMINISTER)
(571) 484-4472
Entity
Organization
Contact information
Practice address
1116 S CHURCH ST, MOUNT OLIVE, NC 28365-2504
(919) 299-4539
Mailing address
810 KILARNEY DR, FREDERICKSBURG, VA 22407-6558
(571) 484-4472
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
311ZA0620X
Adult Care Home Facility
Primary
—
—
347C00000X
Private Vehicle
—
—
Other
Enumeration date
01/26/2024
Last updated
01/13/2025
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