Healthcare Provider Details

I. General information

NPI: 1114939956
Provider Name (Legal Business Name): FOREST STREET LTC, LLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 FOREST ST
DENVER CO
80207-1944
US

IV. Provider business mailing address

1625 MID VALLEY DR 1-111
STEAMBOAT SPR CO
80487-9010
US

V. Phone/Fax

Practice location:
  • Phone: 303-393-7600
  • Fax: 303-393-7606
Mailing address:
  • Phone: 720-929-0086
  • Fax: 720-929-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberPENDING
License Number StateCO

VIII. Authorized Official

Name: MR. MITCHELL J FRIEDMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential: NHA
Phone: 720-929-0086