Organization
FOUNTAIN LAKE HEALTH AND REHAB INC
Active
Other names
Fountain Lake Health and Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
JOEY MARTIN WIGGINS (PRESIDENT)
(501) 305-3153
Entity
Organization
Contact information
Practice address
351 WOODFIN ST, HOT SPRINGS, AR 71901
(501) 624-5238
(501) 624-2519
Mailing address
2908 HAWKINS DRIVE, SEARCY, AR 72143
(501) 305-3153
(501) 279-3796
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
681
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015254
MEDIPAK
AR
Enumeration date
04/11/2006
Last updated
08/22/2020
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