MEDICARE: WEST FORREST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1659610806
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST FORREST

Provider Business Mailing Address
First Line	:	280 W FORREST ST
Second Line	:
City	:	HARLEM
State	:	GA
Zip	:	30814-4637
Country	:	US
Telephone Number	:	706-556-6005
Fax Number	:	706-556-3267

Provider Business Practice Location Address
First Line	:	280 W FORREST ST
Second Line	:
City	:	HARLEM
State	:	GA
Zip	:	30814-4637
Country	:	US
Telephone Number	:	706-556-6005
Fax Number	:	706-556-3267

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ANGELA K LOKEY
Credential	:
Telephone Number	:	706-556-6005

Provider Enumeration Date	:	02/07/2013
Last Update Date	:	02/07/2013

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Directions to “WEST FORREST ” Practice Location

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