FMG East Lauridsen Boulevard Washington LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FMG EAST LAURIDSEN BOULEVARD WASHINGTON LLC

Practice address

1116 E Lauridsen Blvd
Port Angeles, WA 98362-6640

Phone

(360) 452-9206

Fax

(360) 457-2935

NPI assigned

Dec 18, 2014

Organization subpart

No

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

Authorized official

Name

David C. Keating

Title

Agent

Phone

(414) 908-8058

Specialties & licenses 1

Addresses

Other names 1

• Crestwood Health & Rehabilitation Center Doing business as

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

{
    "created_epoch": "1418860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1629476916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5001 WEST LEMON STREET",
            "address_2": "C/O FOCUS MANAGEMENT GROUP",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336091103",
            "telephone_number": "813-281-0062",
            "fax_number": "813-281-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 E LAURIDSEN BLVD",
            "city": "PORT ANGELES",
            "state": "WA",
            "postal_code": "983626640",
            "telephone_number": "360-452-9206",
            "fax_number": "360-457-2935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMG EAST LAURIDSEN BOULEVARD WASHINGTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KEATING",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "AGENT",
        "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": "Crestwood Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crestwood Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patricia A Flood, LAC
• Kimberly Flores, RN
• Marnae Joyce Flores
• Kyle Flotto-Myers, RN
• James F Flowers, M.D.
• Sara E Folden, MSW
• Jessica Ann Foley, CDPT
• Diane Marie Forsmark, RDH
• Emily Fosnes
• Paige Marie Foth

• Skilled Nursing Facility in Port Angeles, WA
• Providers in Port Angeles, 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 Jul 21, 2022; 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.