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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