FMG Davis Street SNF Wisconsin LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FMG DAVIS STREET SNF WISCONSIN LLC

Doing business as

American Heritage

Practice address

425 Davis St
Hammond, WI 54015-9615

Phone

(715) 796-2218

Fax

(715) 796-5286

NPI assigned

Jan 15, 2015

Last updated

Jan 16, 2015By the provider in NPPES

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

• American Heritage Doing business as

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

{
    "created_epoch": "1421280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421366400000",
    "number": "1104215060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 DAVIS ST",
            "city": "HAMMOND",
            "state": "WI",
            "postal_code": "540159615",
            "telephone_number": "715-796-2218",
            "fax_number": "715-796-5286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 DAVIS ST",
            "city": "HAMMOND",
            "state": "WI",
            "postal_code": "540159615",
            "telephone_number": "715-796-2218",
            "fax_number": "715-796-5286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMG DAVIS STREET SNF WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-15",
        "last_updated": "2015-01-16",
        "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": "American Heritage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Amy Elizabeth Gierl, CFY-SLP
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• Melissa Herbst, COTA

• Skilled Nursing Facility in Hammond, WI
• Providers in Hammond, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2015; 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.