Fountain of Youth Activity Center, LLC
NPI 1134797715ActiveOrganization· PACE Provider Organization· Raytown, MO
PACE Provider Organization in Raytown, Missouri, registered in NPPES in June 2021. The authorized official on file is John Parker, Executive Director.
Overview
| NPI | 1134797715 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jun 11, 2021 |
| Last updated in NPPES | Jun 11, 2021 |
| Certified by provider | Jun 11, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| PACE Provider Organization Primary | 251T00000X | — | — |
| Non-emergency Medical Transport (VAN) | 343900000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|