# FMG WEST FOURTH STREET MICHIGAN LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tendercare Health Center of Leelanau
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457759896
- **Authorized official:** DAVID KEATING (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (414) 908-8058

## Contact information

- **Practice address:** 124 W FOURTH ST, SUTTONS BAY, MI 49682-9733
- **Practice address phone:** (231) 271-1200
- **Practice address fax:** (231) 271-1214
- **Mailing address:** 124 W FOURTH ST, SUTTONS BAY, MI 49682-9733
- **Mailing address phone:** (231) 271-1200
- **Mailing address fax:** (231) 271-1214

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 12/17/2014
- **Last updated:** 12/23/2014