Fountain of Youth Activity Center, LLC
Fountain of Youth Activity Center, LLC is a PACE Provider Organization in Raytown, Missouri. Registered with an NPI since 2021.
- In the registry since
- 2021
- Specialties on file
- 2
What do these letters mean?
- LLC — Limited liability company
- A form of business registration, not a clinical qualification.
Practice location Address checks out
8801 E 63rd St Ste 101Raytown, MO 64133-4865
Phone: (816) 886-0442
Fax: (816) 503-9408
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| PACE Provider Organization (primary) | Taxonomy 251T00000X |
|---|---|
| Non-emergency Medical Transport (VAN) | Taxonomy 343900000X |
Record details
| NPI number | 1134797715 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | John Parker — Executive Director · (816) 503-9865 |
| NPI enumerated | June 11, 2021 |
| Last updated in NPPES | June 11, 2021 |
| Certification date | June 11, 2021 |
| Mailing address | 8801 E 63rd St Ste 101, Raytown, MO 64133-4865 |