FOUNTAIN OF YOUTH, LLC (NPI# 1316205115) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316205115 |
| Entity Type | Organization |
| Organization Name | FOUNTAIN OF YOUTH, LLC |
| Other Organization Name | SEELYVILLE FAMILY PRACTICE |
| Practice Address |
8810 Wabash Ave Terre Haute IN 47803-3908 |
| Practice Telephone | 8122394090 |
| Mailing Telephone | 8122394090 |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2012-04-30 |
| Authorized Official Name | SHERRI JERNBERG (OWNER/OPERATOR) |
| Authorized Official Telephone | 8122394090 |
| Authorized Official Credential | NP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 71002624A | IN | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | PERSONAL NPI NUMBER | 1588821250 | 01 |
| Other Name | Type Code |
|---|---|
| Seelyville Family Practice | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | FOUNTAIN OF YOUTH, LLC | 2450 Ne Mary Rose Pl, Suite 205, Bend, OR 97701 |
| Indiana Business Entities | FOUNTAIN OF YOUTH, LLC | 2427 North Stop 19 Street, Terre Haute, IN 47803 |
| Street Address |
8810 WABASH AVE |
| City | TERRE HAUTE |
| State | IN |
| Zip Code | 47803-3908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407404940 | Union Associated Physicians Clinic LLC | Family Medicine | 2133 South State Road 46, Terre Haute, IN 47803 | 2019-08-28 |
| 1811435209 | Jon Sagarsee | Specialist/Technologist | 613 Gardendale Rd., Terre Haute, IN 47803 | 2017-02-06 |
| 1184086662 | Nicholas Andreasen | Specialist/Technologist | 614 S Dobbs Glen St, Terre Haute, IN 47803 | 2016-03-24 |
| 1568833960 | Dawn D Christmas | Pharmacist | 5600 New Margaret Ave, Terre Haute, IN 47803 | 2015-10-12 |
| 1902277437 | Erin Haggart | Pharmacist | 5600 New Margaret Avenue, Pharmacy, Terre Haute, IN 47803 | 2015-10-09 |
| 1508272881 | Shirish Sachdeva | Physical Therapist | 5506 E New Margaret Dr, Terre Haute, IN 47803 | 2014-07-07 |
| 1043634041 | Jed Arseneau | Specialist/Technologist | 928 Barton Avenue, Terre Haute, IN 47803 | 2014-02-11 |
| 1689978389 | Affordable Dentures - Terre Haute, P.C. | Dentist | 2801 South Anton Road, Affordable Dentures - Terre Haute, P.C., Terre Haute, IN 47803 | 2011-01-10 |
| 1003003534 | Etheridge Chiropractic Clinic Inc | Chiropractor | 631 S 25th Street, Terre Haute, IN 47803 | 2007-09-28 |
| 1922197599 | David Edward Cox | Dentist | 2510 Hulman St, Terre Haute, IN 47803 | 2006-10-12 |
| Find all providers in zip 47803 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| 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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|---|---|---|---|---|
| 1366076564 | Sullivan County Community Hospital | Clinic/Center | 4146 S 7th St Ste B, Terre Haute, IN 47802-4123 | 2020-02-26 |
| 1891044681 | Wabash Valley Health Center, Inc. | Clinic/Center | 1436 Locust Street, Terre Haute, IN 47807-1648 | 2012-09-07 |
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| 1346867942 | Henry County Memorial Hospital | Clinic/Center | 4760 National Rd W, Richmond, IN 47374-4745 | 2020-06-30 |
| 1114541935 | Ourhealth Physicians Group, LLC | Clinic/Center | 9998 N Michigan Rd, Carmel, IN 46032-9640 | 2020-06-08 |
| 1497306310 | Activate Healthcare - Ibew Local 153/ua Local 172 South Bend | Clinic/Center | 3371 W Cleveland Road Ext Ste 120, South Bend, IN 46628-9780 | 2019-09-23 |
| 1437707601 | Nuyou Therapies, LLC | Clinic/Center | 5401 Vogel Rd Ste 740, Evansville, IN 47715-7834 | 2019-08-29 |
| 1306492160 | Deaconess Clinic, Inc. | Clinic/Center | 315 N 1st Ave, Evansville, IN 47710-1218 | 2019-08-16 |
| 1750941902 | Unity Healthcare LLC | Clinic/Center | 1345 Unity Pl Ste 220, Lafayette, IN 47905-5761 | 2019-06-19 |
| 1538622899 | Transitions Recovery, LLC | Clinic/Center | 2406 G St, Bedford, IN 47421-5120 | 2019-04-12 |
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| City | TERRE HAUTE |
| Zip Code | 47803 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.