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Fountain Of Youth, Llc
Clinic/Center in Terre Haute, Indiana
NPI 1316205115

Fountain Of Youth, Llc is a Clinic/Center based in Terre Haute, IN. Fountain Of Youth, Llc practices in Terre Haute, IN. The NPI Number for Fountain Of Youth, Llc is 1316205115 and holds a License No. 71002624A (Indiana).

The current practice location address for Fountain Of Youth, Llc is 8810 Wabash Ave, Terre Haute, IN and can be reached out via phone at 812-239-4090.

Location: 8810 Wabash Ave, Terre Haute, IN, 47803-3908
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1316205115
Provider Name
Fountain Of Youth, Llc
Credential
Provider Entity Type
Organization
Address
8810 Wabash Ave, Terre Haute, IN, 47803-3908
Phone Number
812-239-4090
Fax Number
Provider Enumeration Date
04/30/2012
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1588821250 01 IN PERSONAL NPI NUMBER
institution
Provider Business Practice Location Address Details
Address
8810 Wabash Ave
City
Terre Haute
State
Indiana
Zip
47803-3908
Phone Number
812-239-4090
Fax Number
person
Provider Business Mailing Address Details
Address
8810 Wabash Ave
City
Terre Haute
State
Indiana
Zip
47803-3908
Phone Number
812-239-4090
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
-
Taxonomy
261Q00000X
License No.
71002624A (Indiana)
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
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