FMG North Garrison Road Washington LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FMG NORTH GARRISON ROAD WASHINGTON LLC

Practice address

1015 N Garrison Rd
Vancouver, WA 98664-1354

Phone

(360) 694-7501

Fax

(360) 694-8148

NPI assigned

Dec 24, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David Keating

Title

Authorized Official

Phone

(414) 908-8058

Specialties & licenses 1

Addresses

Other names 1

• Pacific Specialty and Rehabilitative Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1419379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419811200000",
    "number": "1083002141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 N GARRISON RD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641354",
            "telephone_number": "360-694-7501",
            "fax_number": "360-694-8148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 N GARRISON RD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641354",
            "telephone_number": "360-694-7501",
            "fax_number": "360-694-8148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMG NORTH GARRISON ROAD WASHINGTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-24",
        "last_updated": "2014-12-29",
        "status": "A",
        "authorized_official_last_name": "KEATING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "414-908-8058"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Specialty and Rehabilitative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kalee-Glynn Mikiko Floyd, LMHCA
• Kiersten Norene Flyckt, PHARMD
• Christina Flynn, LW61326712
• Matthew James Flynn, M.D.
• Mikiko Flynn, M.D.
• Emilymae F Fobell
• Focal Clinic Inc
• Kathleen Fockler, RN
• Kenneth Michael Foerster, MD
• Lita Fogle, MA

• Skilled Nursing Facility in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.