1649315565 NPI number — FOREST HILL HEALTH CARE CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649315565 NPI number — FOREST HILL HEALTH CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOREST HILL HEALTH CARE CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649315565
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
497 MOUNT PROSPECT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07104-2903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-482-2351
Provider Business Mailing Address Fax Number:
973-482-6752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
497 MOUNT PROSPECT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07104-2903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-482-2351
Provider Business Practice Location Address Fax Number:
973-482-6752
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FEIG
Authorized Official First Name:
ELAYNE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF BUSINESS OFFICE
Authorized Official Telephone Number:
973-482-2351

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7411600 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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