Fmg North Wisconsin Street Wisconsin LLC
NPI #1205228525 in Port Washington, Wisconsin
Provider Information
- NPI Number
- 1205228525
- Entity Type
- Organization
- Organization Name
- Fmg North Wisconsin Street Wisconsin LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Feb 24, 2015
- Last Updated
- Feb 24, 2015
Practice Location
- Address
- 1119 N WISCONSIN ST
- City
- Port Washington
- State
- Wisconsin
- ZIP Code
- 53074-1209
- Phone
- (262) 284-5892
Authorized Official
- Name
- DAVID KEATING
- Title
- AUTHORIZED OFFICIAL
- Phone
- (414) 908-8058
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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