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General NPI Number Information
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NPI Number | 1255722815
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Entity Type | Organization
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Legal Business Name | FORESIDE MANAGMENT COMPANY
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 26023 ACERO
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City | MISSION VIEJO
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State | CA
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Zip | 92691-7941
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Country | US
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Telephone | 949-837-7000
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Fax | 949-334-5323
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Provider Business Mailing Address
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Address Line | 26023 ACERO
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City | MISSION VIEJO
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State | CA
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Zip | 92691-7941
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Country | US
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Telephone | 949-837-7000
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Fax | 949-334-5323
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Authorized Official
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Title or Position | PRESIDENT & CHIEF EXECUTIVE OFFICER
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Name | MARK E. WOODSUM
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Credential |
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Telephone | 949-966-1933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 550001632
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License Number State | CA
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