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General NPI Number Information
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NPI Number | 1699987586
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Entity Type | Organization
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Legal Business Name | FOREST PLAZA ASSISTED LIVING
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 635 HIGHWAY 9 EAST
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City | FOREST CITY
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State | IA
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Zip | 50436
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Country | US
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Telephone | 641-585-1555
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Fax | 641-585-2522
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Provider Business Mailing Address
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Address Line | 635 HIGHWAY 9 EAST
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City | FOREST CITY
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State | IA
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Zip | 50436
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Country | US
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Telephone | 641-585-1555
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Fax | 641-585-2522
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Authorized Official
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Title or Position | MANAGER
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Name | LONNY SMITH
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Credential | SW
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Telephone | 641-585-1555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | SO131
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License Number State | IA
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