Fountain of Youth Alf Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

AL9411 Issued in FL

Legal business name

FOUNTAIN OF YOUTH ALF INC

Practice address

9001 Bana Villa CT
Tampa, FL 33635

Phone

(813) 884-4166

NPI assigned

May 23, 2014

Organization subpart

No

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

Authorized official

Name

Amada Hernandez

Title

Owner

Phone

(813) 884-4166

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1400803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400803200000",
    "number": "1356753438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9001 BANA VILLA CT",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336351072",
            "telephone_number": "813-884-4166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9001 BANA VILLA CT",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "33635",
            "telephone_number": "813-884-4166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN OF YOUTH ALF INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-23",
        "last_updated": "2014-05-23",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "AMADA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-884-4166"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL9411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Misti Jo Foth, APRN
• Paul Francis Foti, M.D.
• Kristen Fotopoulos, APRN, NNP-BC
• Philip R Foulis, MD,MPH
• Foundations for Growth, PLLC
• Kathy Fountain-Robertson, LMHC
• Benjamin Fountain
• Four Seasons Behavioral Health Collaborative Inc.
• Four Winds Counseling LLC
• Yohan Fournier

• Assisted Living Facility in Tampa, FL
• Providers in Tampa, FL by specialty
• Assisted Living Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2014; 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.