Provider Demographics
NPI:1114956265
Name:FMSC WEBER CITY OPERATING COMPANY LLC
Entity Type:Organization
Organization Name:FMSC WEBER CITY OPERATING COMPANY LLC
Other - Org Name:BRIAN CENTER HEALTH & REHABILITATION CENTER/SCOTT COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUAY
Authorized Official - Suffix:III
Authorized Official - Credentials:CPA
Authorized Official - Phone:786-888-3310
Mailing Address - Street 1:1055 NE 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5804
Mailing Address - Country:US
Mailing Address - Phone:786-888-3310
Mailing Address - Fax:
Practice Address - Street 1:377 CLONCE ST
Practice Address - Street 2:
Practice Address - City:WEBER CITY
Practice Address - State:VA
Practice Address - Zip Code:24290-7269
Practice Address - Country:US
Practice Address - Phone:276-386-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA314000000314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA49-5208-1/VAMedicaid
VA495208Medicare Oscar/Certification
N/AMedicare UPIN