Provider Demographics
NPI:1134187461
Name:FOREST GLEN NURSING CARE, LLC
Entity type:Organization
Organization Name:FOREST GLEN NURSING CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-933-2500
Mailing Address - Street 1:2700 BARKER ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1001
Mailing Address - Country:US
Mailing Address - Phone:301-565-0300
Mailing Address - Fax:301-933-4596
Practice Address - Street 1:2700 BARKER ST
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1001
Practice Address - Country:US
Practice Address - Phone:301-565-0300
Practice Address - Fax:301-933-4596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15029314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD215338Medicare ID - Type Unspecified