Provider Demographics
NPI:1235851221
Name:FOREST STREET LTC, LLLP
Entity Type:Organization
Organization Name:FOREST STREET LTC, LLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-929-0086
Mailing Address - Street 1:3440 YOUNGFIELD ST # 358
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-5245
Mailing Address - Country:US
Mailing Address - Phone:720-929-0086
Mailing Address - Fax:720-929-0381
Practice Address - Street 1:3345 FOREST ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80207-1944
Practice Address - Country:US
Practice Address - Phone:303-393-7600
Practice Address - Fax:303-393-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000143670Medicaid