FMG Mulberry Street Wisconsin LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FMG MULBERRY STREET WISCONSIN LLC

Doing business as

Willowbrook Nursing & Rehabilitation Center

Practice address

901 Mulberry St
Lake Mills, WI 53551-1335

Phone

(920) 648-8344

NPI assigned

Feb 24, 2015

Last updated

Feb 24, 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

• Willowbrook 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": "1700278025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 MULBERRY ST",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535511335",
            "telephone_number": "920-648-8344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MULBERRY ST",
            "city": "LAKE MILLS",
            "state": "WI",
            "postal_code": "535511335",
            "telephone_number": "920-648-8344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FMG MULBERRY 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": "Willowbrook Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emily Enstad, ATR, LPC
• Extendicare Health Facilities, Inc. (Willowbrook Nursing & Rehabilitation Center)
• Steven John Fahsel, DDS
• Venessa Lee Farn, MS,LPC-SASD,NCC,CTS
• Sara Fitch
• Linda M Foley
• Debra Rose Fritz, PTA
• Debra A Fuller, RN
• Jason Carl Gatlin, M.P.T.
• Gregory D Anderson (Anderson Chiropractic Office)

• Skilled Nursing Facility in Lake Mills, WI
• Providers in Lake Mills, 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.