Organization
FMG NORTHEAST WEIDLER STREET OREGON LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID C. KEATING (AGENT)
(414) 908-8058
Entity
Organization
Contact information
Practice address
11325 NE WEIDLER ST, PORTLAND, OR 97220-1950
(503) 253-1181
(503) 253-1871
Mailing address
5001 WEST LEMON STREET, C/O FOCUS MANAGEMENT GROUP, TAMPA, FL 33609-1103
(813) 281-0062
(813) 281-0063
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
12/24/2014
Last updated
11/07/2017
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