FMG Hoover Street Wisconsin LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FMG HOOVER STREET WISCONSIN LLC

Doing business as

Willowdale Nursing & Rehabilitation Center

Practice address

1610 Hoover St
New Holstein, WI 53061-1636

Phone

(920) 898-5706

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

• Willowdale Nursing & 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": "1336531656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 HOOVER ST",
            "city": "NEW HOLSTEIN",
            "state": "WI",
            "postal_code": "530611636",
            "telephone_number": "920-898-5706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 HOOVER ST",
            "city": "NEW HOLSTEIN",
            "state": "WI",
            "postal_code": "530611636",
            "telephone_number": "920-898-5706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMG HOOVER 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": "Willowdale Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joseph Allen Delgado, OD
• Meghan R Driessen, PTA
• Hany M Elewa, DC PHD NCEA DIP
• Extendicare Health Facilities, Inc. (Willowdale Nursing & Rehabilitation Center)
• Eye Care Center of New Holstein, LLC
• Connie M Gehl
• Mary Ann Halbach, COTA
• Amber Heimermann, PTA
• Homestead Care Center LLC (Atrium Post Acute Care of New Holstein)
• Megan Joyce Koehler, RN

• Skilled Nursing Facility in New Holstein, WI
• Providers in New Holstein, 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.