Healthcare Provider Details

I. General information

NPI: 1285032573
Provider Name (Legal Business Name): FMG WEST HEMLOCK STREET WASHINGTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W HEMLOCK ST
SEQUIM WA
98382-3718
US

IV. Provider business mailing address

5001 WEST LEMON STREET C/O FOCUS MANAGEMENT GROUP
TAMPA FL
33609-1103
US

V. Phone/Fax

Practice location:
  • Phone: 360-582-2400
  • Fax: 360-582-2419
Mailing address:
  • Phone: 813-281-0062
  • Fax: 813-281-0063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DAVID C. KEATING
Title or Position: AGENT
Credential:
Phone: 414-908-8058