Provider Demographics
NPI:1700823614
Name:FORREST OAKS MANAGEMENT COMPANY, LLC
Entity Type:Organization
Organization Name:FORREST OAKS MANAGEMENT COMPANY, LLC
Other - Org Name:FOREST OAKS NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V. PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-445-2517
Mailing Address - Street 1:118 E LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76446-1941
Mailing Address - Country:US
Mailing Address - Phone:254-445-2517
Mailing Address - Fax:254-445-3690
Practice Address - Street 1:726 E COKE ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:TX
Practice Address - Zip Code:76531-2346
Practice Address - Country:US
Practice Address - Phone:254-386-3147
Practice Address - Fax:254-386-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113036314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-5473Medicare ID - Type Unspecified