Fountain Lake Health and Rehab Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

681 Issued in AR

Legal business name

FOUNTAIN LAKE HEALTH AND REHAB INC

Practice address

351 Woodfin St
Hot Springs, AR 71901

Phone

(501) 624-5238

Fax

(501) 624-2519

NPI assigned

Apr 11, 2006

Organization subpart

No

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

Authorized official

Name

Joey Martin Wiggins

Title

President

Phone

(501) 305-3153

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Fountain Lake Health and Rehab Doing business as

Locations

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

{
    "created_epoch": "1144713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902869787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2908 HAWKINS DRIVE",
            "city": "SEARCY",
            "state": "AR",
            "postal_code": "72143",
            "telephone_number": "501-305-3153",
            "fax_number": "501-279-3796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 WOODFIN ST",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "71901",
            "telephone_number": "501-624-5238",
            "fax_number": "501-624-2519"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN LAKE HEALTH AND REHAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WIGGINS",
        "authorized_official_first_name": "JOEY",
        "authorized_official_middle_name": "MARTIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "501-305-3153"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "AR",
            "license": "681",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDIPAK",
            "identifier": "015254",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountain Lake Health and Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Caroline Anne Foshee, CRNA
• Misty L Foshee, APN
• Jacqueline Marie Foster, MHPP
• Fountain Lake Family Pharmacy LLC
• Fountain Lake Family Pharmacy LLC
• Fountain Lake School
• Mikell Foust, APRN, PMHNP-BC
• Lindsay Fowler, M.S., CCC-SLP
• Kaylee Fox - Cox, LCSW
• Jacquelyn Fox-Tomassi, CBT

• All providers in Hot Springs, AR
• Skilled Nursing Facility in Arkansas

• 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.