Provider Demographics
NPI:1982063772
Name:RL FOUNTAINWOOD 1
Entity Type:Organization
Organization Name:RL FOUNTAINWOOD 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:316-992-2119
Mailing Address - Street 1:2004 FOUNTAINWOOD
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-2662
Mailing Address - Country:US
Mailing Address - Phone:620-259-8033
Mailing Address - Fax:620-259-8043
Practice Address - Street 1:2004 FOUNTAINWOOD
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2662
Practice Address - Country:US
Practice Address - Phone:620-259-8033
Practice Address - Fax:620-259-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB040002311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home