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General NPI Number Information
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NPI Number | 1972524858
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Entity Type | Organization
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Legal Business Name | FMRM,LLC
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 5100 JACKSON STREET EXT
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2317
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Country | US
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Telephone | 318-445-5215
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Fax | 318-442-8067
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Provider Business Mailing Address
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Address Line | 5100 JACKSON STREET EXT
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2317
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Country | US
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Telephone | 318-445-5215
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Fax | 318-442-8067
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | RENEE J MATTHEWS
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Credential |
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Telephone | 318-445-5215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 786
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License Number State | LA
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