Provider Demographics
NPI:1689920647
Name:FOREST OAKS OF SPRING HILL, LLC
Entity Type:Organization
Organization Name:FOREST OAKS OF SPRING HILL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-683-3323
Mailing Address - Street 1:8055 FOREST OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-2406
Mailing Address - Country:US
Mailing Address - Phone:352-683-3323
Mailing Address - Fax:352-686-1465
Practice Address - Street 1:8055 FOREST OAKS BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-2406
Practice Address - Country:US
Practice Address - Phone:352-683-3323
Practice Address - Fax:352-686-1465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL7179310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691830100Medicaid