Provider Demographics
NPI:1043636699
Name:FPNC, INC.
Entity Type:Organization
Organization Name:FPNC, INC.
Other - Org Name:TWIN LAKES THERAPY AND LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-932-0050
Mailing Address - Street 1:6152 HIGHWAY 202 E
Mailing Address - Street 2:
Mailing Address - City:FLIPPIN
Mailing Address - State:AR
Mailing Address - Zip Code:72634-9726
Mailing Address - Country:US
Mailing Address - Phone:870-453-4603
Mailing Address - Fax:870-453-1900
Practice Address - Street 1:6152 HIGHWAY 202 E
Practice Address - Street 2:
Practice Address - City:FLIPPIN
Practice Address - State:AR
Practice Address - Zip Code:72634-9726
Practice Address - Country:US
Practice Address - Phone:870-453-4603
Practice Address - Fax:870-453-1900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAGLE HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-06
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1045314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR202099311Medicaid
AR202099311Medicaid