Healthcare Provider Details

I. General information

NPI: 1134187461
Provider Name (Legal Business Name): FOREST GLEN NURSING CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BARKER ST
SILVER SPRING MD
20910-1001
US

IV. Provider business mailing address

2700 BARKER ST
SILVER SPRING MD
20910-1001
US

V. Phone/Fax

Practice location:
  • Phone: 301-565-0300
  • Fax: 301-933-4596
Mailing address:
  • Phone: 301-565-0300
  • Fax: 301-933-4596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number15029
License Number StateMD

VIII. Authorized Official

Name: JONATHAN A. SCHULTZ
Title or Position: MANAGEMENT REPRESENTATIVE
Credential:
Phone: 301-933-2500