Healthcare Provider Details

I. General information

NPI: 1356085245
Provider Name (Legal Business Name): FOREST HILL SNF OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 FOREST VALLEY DR
FOREST HILL MD
21050-2831
US

IV. Provider business mailing address

109 FOREST VALLEY DR
FOREST HILL MD
21050-2831
US

V. Phone/Fax

Practice location:
  • Phone: 410-879-1120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY KAGAN
Title or Position: AUTHORIZED OFIICIAL
Credential:
Phone: 410-207-4099