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General NPI Number Information
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NPI Number | 1811284912
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Entity Type | Organization
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Legal Business Name | FOREST FAMILY CARE, INC
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Dates
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Enumeration Date | 07/09/2011
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 3874 RENEE DR UNIT B
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-4358
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Country | US
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Telephone | 843-903-4500
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Fax | 843-903-4505
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Provider Business Mailing Address
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Address Line | 3874 RENEE DR UNIT B
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-4358
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Country | US
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Telephone | 843-997-2380
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Fax | 843-903-4505
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Authorized Official
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Title or Position | OWNER/CEO
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Name | JESSICA GRACE SMITH CHASSE
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Credential | FNP-C
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Telephone | 843-903-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F2018
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License Number State | SC
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