Provider Demographics
NPI:1528361326
Name:FOREST HILL RESIDENTIAL CARE HOME
Entity Type:Organization
Organization Name:FOREST HILL RESIDENTIAL CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-888-1700
Mailing Address - Street 1:213 CLARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:VT
Mailing Address - Zip Code:05655-9218
Mailing Address - Country:US
Mailing Address - Phone:802-888-1700
Mailing Address - Fax:802-888-9944
Practice Address - Street 1:213 CLARK DRIVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05655-9218
Practice Address - Country:US
Practice Address - Phone:802-888-1700
Practice Address - Fax:802-888-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0597313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility