FMG East Geneva Street Wisconsin LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FMG EAST GENEVA STREET WISCONSIN LLC

Doing business as

Willowfield Nursing & Rehabilitation

Practice address

905 E Geneva St
Delavan, WI 53115-1922

Phone

(262) 728-6319

Fax

(262) 728-6693

NPI assigned

Jan 16, 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

• Willowfield Nursing & Rehabilitation Doing business as

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

{
    "created_epoch": "1421366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421366400000",
    "number": "1659760452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 E GENEVA ST",
            "city": "DELAVAN",
            "state": "WI",
            "postal_code": "531151922",
            "telephone_number": "262-728-6319",
            "fax_number": "262-728-6693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 E GENEVA ST",
            "city": "DELAVAN",
            "state": "WI",
            "postal_code": "531151922",
            "telephone_number": "262-728-6319",
            "fax_number": "262-728-6693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMG EAST GENEVA STREET WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-16",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willowfield Nursing & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jean Ellen Duesterbeck, REGISTERED NURSE
• Pascalle Dumez, PT
• Mark J Eggerichs, R.PH.
• Extendicare Homes, Inc. (Willowfield Nursing and Rehabilitation Center)
• Michael J Fehling, MD
• Jessica Lynne Formea, MS, CFY-SLP
• Nicholas Matthew Franz, PHARMD
• Destry Allen Fritz, COTA
• Furnishing Solutions (Slumberland)
• Maria Teresa Galgano Chadha, DDS

• Skilled Nursing Facility in Delavan, WI
• Providers in Delavan, 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.