Healthcare Provider Details

I. General information

NPI: 1659754166
Provider Name (Legal Business Name): FORTIS MANAGEMENT HOLDINGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2015
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W MICHIGAN ST
MILWAUKEE WI
53203-2903
US

IV. Provider business mailing address

111 W MICHIGAN ST
MILWAUKEE WI
53203-2903
US

V. Phone/Fax

Practice location:
  • Phone: 414-908-8019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DYLAN MANN
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 414-908-8623