FMG North Wisconsin Street Wisconsin LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FMG NORTH WISCONSIN STREET WISCONSIN LLC

Doing business as

Heritage Nursing and Rehabilitation Center

Practice address

1119 N Wisconsin St
Port Washington, WI 53074-1209

Phone

(262) 284-5892

Fax

(262) 284-0234

NPI assigned

Feb 24, 2015

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

• Heritage Nursing and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1424736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424736000000",
    "number": "1205228525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 N WISCONSIN ST",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530741209",
            "telephone_number": "262-284-5892",
            "fax_number": "262-284-0234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 N WISCONSIN ST",
            "city": "PORT WASHINGTON",
            "state": "WI",
            "postal_code": "530741209",
            "telephone_number": "262-284-5892",
            "fax_number": "262-284-0234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMG NORTH WISCONSIN STREET WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-24",
        "last_updated": "2015-02-24",
        "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": "Heritage Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maria C Filut, LCSW, APSW, SAC-IT
• Vickie Finch
• Donald C Fischer, MD
• Nicole J Fischer, MFT-IT APSW
• Mark R Fitzsimmons, MD
• Forefront Dermatology, S.C.
• Taylor Freding
• Jamie M Freund, LPC
• Thomas Karl Galten, LCSW
• Jennifer Gatton

• Skilled Nursing Facility in Port Washington, WI
• Providers in Port Washington, 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 Feb 24, 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.