Fountain of Youth LLC Residential Care

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

FOUNTAIN OF YOUTH LLC RESIDENTIAL CARE

Practice address

1116 S Church St
Mount Olive, NC 28365-2504

Phone

(919) 299-4539

NPI assigned

Jan 26, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sadio Sykes

Title

Administer

Phone

(571) 484-4472

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736726400000",
    "number": "1306608195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 KILARNEY DR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224076558",
            "telephone_number": "571-484-4472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 S CHURCH ST",
            "city": "MOUNT OLIVE",
            "state": "NC",
            "postal_code": "283652504",
            "telephone_number": "919-299-4539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN OF YOUTH LLC RESIDENTIAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-26",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A",
        "authorized_official_last_name": "SYKES",
        "authorized_official_first_name": "SADIO",
        "authorized_official_title_or_position": "ADMINISTER",
        "authorized_official_telephone_number": "571-484-4472"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Family First Support Center Inc
• Family First Support Center Inc
• Eugene Fleming
• Jeanette Fleming
• Paula A Fleming, LPC, LPCS, LCAS, CCS
• Fonda Frink
• Elizabeth F. Garcia, MS, CCC-SLP
• Bryon M Geer, DO
• Kristen Gibson
• Glenn and Martin Drug

• Adult Care Home Facility in Mount Olive, NC
• Providers in Mount Olive, NC by specialty
• Adult Care Home Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.