=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346393642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOREST HEALTH SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2007
-----------------------------------------------------
Last Update Date | 09/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 FOREST ST
-----------------------------------------------------
City | BUHL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55713-0724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-258-8742
-----------------------------------------------------
Fax | 218-258-8767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 FOREST ST PO BOX 724
-----------------------------------------------------
City | BUHL
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55713-0724
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-258-8742
-----------------------------------------------------
Fax | 218-258-8767
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR PRESIDENT
-----------------------------------------------------
Name | MS. DEBRA S DOUGHTY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 218-258-8742
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 333238
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------