Provider Demographics
NPI:1376664177
Name:TI HEALTHCARE I LLC
Entity Type:Organization
Organization Name:TI HEALTHCARE I LLC
Other - Org Name:FOREST MANOR HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-459-4128
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:NJ
Mailing Address - Zip Code:07844-0283
Mailing Address - Country:US
Mailing Address - Phone:908-459-4128
Mailing Address - Fax:908-459-4513
Practice Address - Street 1:145 STATE PARK ROAD
Practice Address - Street 2:
Practice Address - City:BLAIRSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07825-4206
Practice Address - Country:US
Practice Address - Phone:908-459-4128
Practice Address - Fax:908-459-4513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ062103314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9032401Medicaid
NJ9032401Medicaid