Healthcare Provider Details

I. General information

NPI: 1700823614
Provider Name (Legal Business Name): FORREST OAKS MANAGEMENT COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 E COKE ST
HAMILTON TX
76531-2346
US

IV. Provider business mailing address

118 E LIVE OAK ST
DUBLIN TX
76446-1941
US

V. Phone/Fax

Practice location:
  • Phone: 254-386-3147
  • Fax: 254-386-5444
Mailing address:
  • Phone: 254-445-2517
  • Fax: 254-445-3690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number113036
License Number StateTX

VIII. Authorized Official

Name: MRS. BOBBIE M. NICHOLS
Title or Position: V. PRESIDENT
Credential:
Phone: 254-445-2517