Healthcare Provider Details

I. General information

NPI: 1114956265
Provider Name (Legal Business Name): FMSC WEBER CITY OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 CLONCE ST
WEBER CITY VA
24290-7269
US

IV. Provider business mailing address

1055 NE 125TH ST
NORTH MIAMI FL
33161-5804
US

V. Phone/Fax

Practice location:
  • Phone: 276-386-9444
  • Fax:
Mailing address:
  • Phone: 786-888-3310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number314000000
License Number StateVA

VIII. Authorized Official

Name: MR. THEODORE M DUAY III
Title or Position: CHIEF FINANCIAL OFFICER
Credential: C.P.A.
Phone: 786-888-3310