Provider Demographics
NPI:1497902670
Name:J.C. FORESTER INC.
Entity Type:Organization
Organization Name:J.C. FORESTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-777-9908
Mailing Address - Street 1:12230 IRON BRIDGE RD STE D
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-1534
Mailing Address - Country:US
Mailing Address - Phone:804-777-9908
Mailing Address - Fax:804-777-9056
Practice Address - Street 1:12230 IRONRIDGE RD SUITE D
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1669
Practice Address - Country:US
Practice Address - Phone:804-777-9908
Practice Address - Fax:804-777-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050490305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service