# FMG EAST LAURIDSEN BOULEVARD WASHINGTON LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Crestwood Health & Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629476916
- **Authorized official:** DAVID C. KEATING (AGENT)
- **Authorized official phone:** (414) 908-8058

## Contact information

- **Practice address:** 1116 E LAURIDSEN BLVD, PORT ANGELES, WA 98362-6640
- **Practice address phone:** (360) 452-9206
- **Practice address fax:** (360) 457-2935
- **Mailing address:** 5001 WEST LEMON STREET, C/O FOCUS MANAGEMENT GROUP, TAMPA, FL 33609-1103
- **Mailing address phone:** (813) 281-0062
- **Mailing address fax:** (813) 281-0063

## Taxonomy

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

## Other

- **Enumeration date:** 12/18/2014
- **Last updated:** 07/21/2022