Provider Demographics
NPI:1154713337
Name:FORTIS MANAGEMENT GROUP LLC
Entity type:Organization
Organization Name:FORTIS MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:KEUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-908-8019
Mailing Address - Street 1:111 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53203-2903
Mailing Address - Country:US
Mailing Address - Phone:414-908-8019
Mailing Address - Fax:
Practice Address - Street 1:111 W MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-2903
Practice Address - Country:US
Practice Address - Phone:414-908-8019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORTIS MANAGEMENT HOLDINGS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility