Fmg Mulberry Street Wisconsin LLC
NPI #1700278025 in Lake Mills, Wisconsin
Provider Information
- NPI Number
- 1700278025
- Entity Type
- Organization
- Organization Name
- Fmg Mulberry Street Wisconsin LLC
- Primary Specialty
- Skilled Nursing Facility
- Enumeration Date
- Feb 24, 2015
- Last Updated
- Feb 24, 2015
Practice Location
- Address
- 901 MULBERRY ST
- City
- Lake Mills
- State
- Wisconsin
- ZIP Code
- 53551-1335
- Phone
- (920) 648-8344
Authorized Official
- Name
- DAVID KEATING
- Title
- AUTHORIZED OFFICIAL
- Phone
- (414) 908-8058
Specialties & Taxonomy Codes
| Specialty |
|---|
| Skilled Nursing Facility |
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