Provider Demographics
NPI:1790065001
Name:FOREST VIEW HEALTH CENTER, L.L.C.
Entity Type:Organization
Organization Name:FOREST VIEW HEALTH CENTER, L.L.C.
Other - Org Name:FOREST VIEW HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KANE
Authorized Official - Suffix:III
Authorized Official - Credentials:MED, LPC, SAC, LCSW
Authorized Official - Phone:262-242-3810
Mailing Address - Street 1:11035 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2541
Mailing Address - Country:US
Mailing Address - Phone:414-529-9044
Mailing Address - Fax:414-529-9055
Practice Address - Street 1:11035 W FOREST HOME AVE
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2541
Practice Address - Country:US
Practice Address - Phone:414-529-9044
Practice Address - Fax:414-529-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care