NPIMap

Organization Active NPI

Lagrange Troup County Hospital Authority

Doing business as Twin Fountains Home

  • Skilled Nursing Facility
  • Lagrange, GA
National Provider Identifier
1346214996
Registry record updated Mar 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LAGRANGE TROUP COUNTY HOSPITAL AUTHORITY
Doing business as
Twin Fountains Home
Practice address
1400 Hogansville Rd
Lagrange, GA 30241-1422
Phone
(706) 882-0121
Fax
(706) 845-3902
NPI assigned
Feb 13, 2006
Last updated
Mar 17, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gerald N Fulks
Title
President Ceo
Phone
(706) 845-3244

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1400 Hogansville Rd
Lagrange, GA 30241-1422

Mailing address

1514 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 882-0121

Other identifiers 1

IdentifierTypeStateIssuer
00142843AMedicaidGA

Other names 1

  • Twin Fountains Home Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lagrange Troup County Hospital Authority3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

120 Glenn Bass Rd
Lagrange, GA 30240
Phone (706) 845-3291

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237248000000",
    "number": "1346214996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 VERNON RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302404131",
            "telephone_number": "706-882-0121",
            "fax_number": "706-845-3902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 HOGANSVILLE RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302411422",
            "telephone_number": "706-882-0121",
            "fax_number": "706-845-3902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAGRANGE TROUP COUNTY HOSPITAL AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-13",
        "last_updated": "2009-03-17",
        "status": "A",
        "authorized_official_last_name": "FULKS",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "706-845-3244",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00142843A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Twin Fountains Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lagrange, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.