Provider Demographics
NPI:1710974936
Name:FOREST MANOR HEALTH CARE CENTER, INC.
Entity Type:Organization
Organization Name:FOREST MANOR HEALTH CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:I
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
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:HOPE
Practice Address - State:NJ
Practice Address - Zip Code:07844
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:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ315224Medicare ID - Type Unspecified