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1811385974
FMG WEST LACROSSE AVENUE IDAHO LLC
COEUR D ALENE, ID
NPI
1811385974
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Entity Type
Organization
Authorized Contact
DAVID C. KEATING
Secretary Agent
414-908-8058
Organization Subpart ?
No
Primary Taxonomy
314000000X Skilled Nursing Facility
Enumeration Date
2014-12-24
Last Update Date
2017-11-07
Business Address
FMG WEST LACROSSE AVENUE IDAHO LLC
210 W LACROSSE AVE
COEUR D ALENE, ID 83814-2403
Phone number: 208-664-2185
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Mailing Address
FMG WEST LACROSSE AVENUE IDAHO LLC
5001 WEST LEMON STREET C/O FOCUS MANAGEMENT GROUP
TAMPA, FL 33609-1103
Phone number: 813-281-0062
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