MEDICARE: FOUNTAIN LAKE SCHOOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326261553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNTAIN LAKE SCHOOL

Provider Business Mailing Address
First Line	:	4207 PARK AVE
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-9473
Country	:	US
Telephone Number	:	501-262-5950
Fax Number	:	501-262-5960

Provider Business Practice Location Address
First Line	:	4207 PARK AVE
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-9473
Country	:	US
Telephone Number	:	501-262-5950
Fax Number	:	501-262-5960

Authorized Official
Title or Position	:	SPECIAL EDUCATION SUPERVISOR
Name	:	COURTNEY EUBANKS
Credential	:	MSE
Telephone Number	:	501-701-1768

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	03/01/2011

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Directions to “FOUNTAIN LAKE SCHOOL ” Practice Location

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