Provider Demographics
NPI:1972524858
Name:FMRM,LLC
Entity Type:Organization
Organization Name:FMRM,LLC
Other - Org Name:MATTHEWS MEMORIAL HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-445-5215
Mailing Address - Street 1:5100 JACKSON STREET EXT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2317
Mailing Address - Country:US
Mailing Address - Phone:318-445-5215
Mailing Address - Fax:318-442-8067
Practice Address - Street 1:5100 JACKSON STREET EXT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2317
Practice Address - Country:US
Practice Address - Phone:318-445-5215
Practice Address - Fax:318-442-8067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA786314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1514624Medicaid
LA31056OtherBLUE CROSS BLUE SHIELD
LA1514624Medicaid