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General NPI Number Information
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NPI Number | 1710804612
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Entity Type | Organization
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Legal Business Name | FOREST GLEN REHABILITATION AND HEALTHCARE CENTER LLC
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Dates
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Enumeration Date | 07/01/2026
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Last Update Date | 07/01/2026
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Provider Practice Location Address
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Address Line | 2165 MONTEGO DR
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City | SPRINGFIELD
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State | OH
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Zip | 45503-6465
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Country | US
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Telephone | 937-390-9913
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Fax |
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Provider Business Mailing Address
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Address Line | 229 ROUTE 70 FL 2
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City | TOMS RIVER
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State | NJ
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Zip | 08755-1026
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICARE AUTHORIZED OFFICIAL
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Name | KEVIN DAUBENMIRE
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Credential |
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Telephone | 732-730-7360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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