Healthcare Provider Details

I. General information

NPI: 1366438418
Provider Name (Legal Business Name): FOREST MANOR CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MEDICAL PLZ
GLEN COVE NY
11542-2108
US

IV. Provider business mailing address

6 MEDICAL PLZ
GLEN COVE NY
11542-2108
US

V. Phone/Fax

Practice location:
  • Phone: 516-671-9010
  • Fax:
Mailing address:
  • Phone: 516-671-9010
  • 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: MADELINE MORITZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 516-671-9010