Fountainbleau of Cape Girardeau, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

032007 Issued in MO

Legal business name

FOUNTAINBLEAU OF CAPE GIRARDEAU, INC.

Practice address

2001 N Kingshighway St
Cape Girardeau, MO 63701-2127

Phone

(573) 335-1999

Fax

(573) 335-1997

NPI assigned

Mar 26, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Shafiq M Malik, PRESIDENT

Title

Administrator

Phone

(573) 335-1999

Specialties & licenses 1

Addresses

Other names 1

• Fountainbleau Lodge Doing business as

Tax ID family

Fountainbleau Lodge2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Fountainbleau of Cape Girardeau Inc.

  • Skilled Nursing Facility
  • Cape Girardeau, MO
  • NPI 1831187152
  NPD tax ID

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831216589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 N KINGSHIGHWAY ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012127",
            "telephone_number": "573-335-1999",
            "fax_number": "573-335-1997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 N KINGSHIGHWAY ST",
            "city": "CAPE GIRARDEAU",
            "state": "MO",
            "postal_code": "637012127",
            "telephone_number": "573-335-1999",
            "fax_number": "573-335-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAINBLEAU OF CAPE GIRARDEAU, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MALIK",
        "authorized_official_first_name": "SHAFIQ",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "573-335-1999",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PRESIDENT"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "032007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountainbleau Lodge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Takaus Rochell Foreman
• Ryan P Fortner, FNP
• Dale H Foster, M.D.
• Reeanna May Foster, BS, MAADC II
• Fountainbleau of Cape Girardeau Inc.
• Brianna Marie Fouts
• Christy M. Fowler, O.D.
• Trisha Fowler, APRN FNP
• Fox Family Dental LLC
• Fox Family Dental, L.L.C.

• Assisted Living Facility in Cape Girardeau, MO
• Providers in Cape Girardeau, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.