Organization
FOUNTAIN OF YOUTH ALF INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMADA HERNANDEZ (OWNER)
(813) 884-4166
Entity
Organization
Contact information
Practice address
9001 BANA VILLA CT, TAMPA, FL 33635
(813) 884-4166
Mailing address
9001 BANA VILLA CT, TAMPA, FL 33635-1072
(813) 884-4166
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL9411
FL
Other
Enumeration date
05/23/2014
Last updated
05/23/2014
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