Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Fountain of Youth LLC Residential Care

Organization Community/Behavioral Health Agency · NPI 1306608195

Fountain of Youth LLC Residential Care is a Community/Behavioral Health Agency in Mount Olive, North Carolina. Registered with an NPI since 2024.

In the registry since
2024
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

1116 S Church St
Mount Olive, NC 28365-2504
Phone: (919) 299-4539
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Care Home Facility (primary) Taxonomy 311ZA0620X
Community/Behavioral Health Agency Taxonomy 251S00000X
Private Vehicle Taxonomy 347C00000X

Record details

NPI number1306608195
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Sadio Sykes — Administer · (571) 484-4472
NPI enumeratedJanuary 26, 2024
Last updated in NPPESJanuary 13, 2025
Certification dateJanuary 13, 2025
Mailing address810 Kilarney Dr, Fredericksburg, VA 22407-6558

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