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Fountain of Youth Rehab, PLLC

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Company Details

Name: Fountain of Youth Rehab, PLLC
Jurisdiction: MISSISSIPPI
Business Type: Limited Liability Company
Status: Good Standing
Effective Date: 08 Nov 2021 (4 years ago)
Business ID: 1310949
ZIP code: 39206
County: Hinds
State of Incorporation: MISSISSIPPI
Principal Office Address: 1111 Meadowbrook RdJackson, MS 39206

Agent

Name Role Address
Kimberly McNair Agent 127 S Roach Street, Apt 1004, Jackson, MS 39201

Organizer

Name Role Address
Kimberly McNair Organizer 127 S Roach Street, Apt 1004, Jackson, MS 39201

Manager

Name Role Address
Kimberly Mychel McNair Manager 127 S Roach Street, apt 1004, Jackson, MS 39201

National Provider Identifier

NPI Number:
1982365300
Certification Date:
2022-10-10

Authorized Person:

Name:
KIMBERLY MCNAIR
Role:
PHYSICAL THERAPIST
Phone:

Taxonomy:

Selected Taxonomy:
225100000X - Physical Therapist
Is Primary:
Yes

Contacts:

Fax:
8665982650

Filings

Type Status Filed Date Description
Annual Report LLC Filed 2025-04-14 Annual Report For Fountain of Youth Rehab, PLLC
Annual Report LLC Filed 2024-04-09 Annual Report For Fountain of Youth Rehab, PLLC
Annual Report LLC Filed 2023-04-14 Annual Report For Fountain of Youth Rehab, PLLC
Annual Report LLC Filed 2022-04-15 Annual Report For Fountain of Youth Rehab, PLLC
Formation Form Filed 2021-11-08 Formation For Fountain of Youth Rehab, PLLC

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Date of last update: 28 May 2025

Sources: Company Profile on Mississippi Secretary of State Website