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Organization
FMG DAVIS STREET SNF WISCONSIN LLC
Active
Organization
FMG DAVIS STREET SNF WISCONSIN LLC
Active
Other names
American Heritage
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID KEATING (AUTHORIZED OFFICIAL)
(414) 908-8058
Entity
Organization
Contact information
Practice address
425 DAVIS ST, HAMMOND, WI 54015-9615
(715) 796-2218
(715) 796-5286
Mailing address
425 DAVIS ST, HAMMOND, WI 54015-9615
(715) 796-2218
(715) 796-5286
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
01/15/2015
Last updated
01/16/2015
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