FMG RANDOM LANE MICHIGAN LLC (NPI# 1629452214) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629452214 |
| Entity Type | Organization |
| Organization Name | FMG RANDOM LANE MICHIGAN LLC |
| Practice Address |
508 Random Ln Gaylord MI 49735-9304 |
| Practice Telephone | 9897322508 |
| Practice Fax Number | 9897315260 |
| Mailing Telephone | 9897322508 |
| Mailing Fax Number | 9897315260 |
| Enumeration Date | 2015-07-14 |
| Last Update Date | 2015-07-14 |
| Authorized Official Name | DAVID KEATING (AUTHORIZED OFFICIAL) |
| Authorized Official Telephone | 4149088058 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831597285 | Fmg Random Lane Michigan LLC | Skilled Nursing Facility | 508 Random Ln, Gaylord, MI 49735-9304 | 2014-12-17 |
| Street Address |
508 RANDOM LN |
| City | GAYLORD |
| State | MI |
| Zip Code | 49735-9304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205806593 | Rosanne Beth Freeman Paz | Family Medicine | 508 Random Ln, Gaylord, MI 49735-9304 | 2006-01-26 |
| 1578186029 | Brooke Ann Sumerix | Occupational Therapist | 508 Random Ln, Gaylord, MI 49735-9304 | 2020-05-19 |
| 1316413073 | Melanie Elizabeth Kulczycki | Occupational Therapist | 508 Random Ln, Gaylord, MI 49735-9304 | 2018-10-22 |
| 1386144673 | Peter Anthony Schaub | Physical Therapist | 508 Random Ln, Gaylord, MI 49735-9304 | 2018-02-14 |
| 1790283497 | Alexis Ann Anderson | Speech-Language Pathologist | 508 Random Ln, Gaylord, MI 49735-9304 | 2018-01-28 |
| 1154848224 | Gaylord Opco, LLC | Skilled Nursing Facility | 508 Random Ln, Gaylord, MI 49735-9304 | 2017-08-29 |
| 1215453691 | Gaylord Opco, LLC | Skilled Nursing Facility | 508 Random Ln, Gaylord, MI 49735-9304 | 2017-08-17 |
| 1053854182 | Jane Ferguson | Contractor | 508 Random Ln, Gaylord, MI 49735-9304 | 2016-11-21 |
| 1982054839 | Samantha Paige Conklin | Speech-Language Pathologist | 508 Random Ln, Gaylord, MI 49735-9304 | 2016-06-21 |
| 1659743821 | Timothy Eric Jones | Occupational Therapist | 508 Random Ln, Gaylord, MI 49735-9304 | 2015-10-27 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306447453 | Jenni Kirt | Social Worker | 407 I-75 Bus N, Gaylord, MI 49735 | 2020-11-05 |
| 1922584986 | Patricia Dovalina | Behavior Technician | 2285 Michaywe Dr, Otsego Lake, MI 49735 | 2018-07-12 |
| 1265944581 | James Hulbert | Social Worker | 407 W Main Street, Gaylord, MI 49735 | 2017-10-26 |
| 1548792625 | Somer Lawes | Behavior Technician | 2443 Castlewood Dr, Gaylord, MI 49735 | 2017-03-29 |
| 1922554161 | Mark David Mcpherson | Counselor | 2136 West M-32, Gaylord, MI 49735 | 2016-08-28 |
| 1689063034 | Liza Brandt | Behavioral Analyst | 6748 Colonial Ct, Gaylord, MI 49735 | 2015-01-22 |
| 1942597224 | Visions for Your Community Care Hhc | Home Health | 2365 N Perch Lake Dr, Gaylord, MI 49735 | 2011-07-07 |
| 1073778304 | Julie Lynn Vandusen | Community Health Worker | 5512 Clubhouse Trail, Gaylord, MI 49735 | 2008-07-25 |
| 1073708798 | Alpine Chiropractic, PC | Chiropractor | 529 S. Wisconsin Ave, Gaylord, MI 49735 | 2007-09-06 |
| 1669675567 | Oral and Maxillofacial Surgery Associates | Dentist | 785 E M32, Gaylord, MI 49735 | 2007-06-07 |
| Find all providers in zip 49735 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366802811 | Susan Spurgeon | Skilled Nursing Facility | 303 N Center Ave, Gaylord, MI 49735-1477 | 2016-02-26 |
| 1750388336 | Gaylord Lakeview Home | Skilled Nursing Facility | 640 3rd St, Gaylord, MN 55334-2297 | 2005-06-28 |
| 1154848224 | Gaylord Opco, LLC | Skilled Nursing Facility | 508 Random Ln, Gaylord, MI 49735-9304 | 2017-08-29 |
| 1215453691 | Gaylord Opco, LLC | Skilled Nursing Facility | 508 Random Ln, Gaylord, MI 49735-9304 | 2017-08-17 |
| 1245602754 | Shawna Elizabeth Butler | Skilled Nursing Facility | 508 Random Ln, Gaylord, MI 49735-9304 | 2015-10-23 |
| 1831597285 | Fmg Random Lane Michigan LLC | Skilled Nursing Facility | 508 Random Ln, Gaylord, MI 49735-9304 | 2014-12-17 |
| 1285820092 | Oak Terrace Health Care Center of Gaylord,llc | Skilled Nursing Facility | 640 3rd St, Gaylord, MN 55334-2297 | 2007-09-15 |
| 1053428052 | Tendercare Select Properties Inc. | Skilled Nursing Facility | 508 Random Ln, Rte. 1, Gaylord, MI 49735-9304 | 2006-08-24 |
| 1598700403 | Tendercare Select Properties Inc. | Skilled Nursing Facility | 508 Random Ln, Rte. 4, Gaylord, MI 49735-9304 | 2006-06-17 |
| 1851341333 | Munson Healthcare Otsego Memorial Hospital | Skilled Nursing Facility | 825 N Center Ave, Gaylord, MI 49735 | 2006-05-12 |
| Find all providers in GAYLORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.