Healthcare Provider Details

I. General information

NPI: 1972524858
Provider Name (Legal Business Name): FMRM,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 JACKSON STREET EXT
ALEXANDRIA LA
71303-2317
US

IV. Provider business mailing address

5100 JACKSON STREET EXT
ALEXANDRIA LA
71303-2317
US

V. Phone/Fax

Practice location:
  • Phone: 318-445-5215
  • Fax: 318-442-8067
Mailing address:
  • Phone: 318-445-5215
  • Fax: 318-442-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number786
License Number StateLA

VIII. Authorized Official

Name: RENEE J MATTHEWS
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 318-445-5215