FOUNTAIN OF YOUTH LLC RESIDENTIAL CARE
NPI 1306608195
Custodial Care Facility - Adult Care Home in Mount Olive, NC

Q: What is Fountain Of Youth LLC Residential Care's specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

Active since January 26, 2024

1116 S CHURCH ST, MOUNT OLIVE, NC 28365(919) 299-4539 Get Directions Write a Review

NPPES record last updated: January 13, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Fountain Of Youth Llc Residential Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FOUNTAIN OF YOUTH LLC RESIDENTIAL CARE (NPI 1306608195) is a healthcare organization registered as an adult care home in Mount Olive, North Carolina and active in the NPI registry since January 2024. The organization lists Sadio Sykes, Administer, as its authorized official.

NPPES Registry Identity

NPI1306608195

Entity TypeOrganization

Primary Taxonomy311ZA0620X

Legal Business NameFOUNTAIN OF YOUTH LLC RESIDENTIAL CARE

Location Address1116 S CHURCH STMount Olive, NC 28365-2504

Mailing Address810 Kilarney DrFredericksburg, VA 22407-6558 · (571) 484-4472

Phone(919) 299-4539

Organization SubpartNo

Authorized OfficialSadio SykesAdminister · (571) 484-4472

Enumeration DateJanuary 26, 2024

Last NPPES UpdateJanuary 13, 2025

NPPES CertifiedJanuary 13, 2025

✔ NPI 1306608195 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyCustodial Care Facility · Adult Care HomeNursing & Custodial Care Facilities

Taxonomy Code311ZA0620X

Definition

A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.

Also ListedCommunity/Behavioral HealthTaxonomy 251S00000X

Also ListedPrivate VehicleTaxonomy 347C00000X

1116 S CHURCH ST, Mount Olive, NC 28365

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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fountain Of Youth LLC Residential Care's NPI number?

The NPI number for Fountain Of Youth LLC Residential Care is 1306608195. It was assigned to this organization in the NPPES registry on January 26, 2024.

Where is Fountain Of Youth LLC Residential Care located?

Fountain Of Youth LLC Residential Care is located at 1116 S Church St, Mount Olive, NC 28365. The listed phone number is (919) 299-4539.

What is Fountain Of Youth LLC Residential Care's specialty?

The primary specialty registered for this NPI is Custodial Care Facility, specializing in Adult Care Home, with taxonomy code 311ZA0620X.

When was this NPI record last updated?

The NPPES record for Fountain Of Youth LLC Residential Care was last updated on January 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.