Provider Demographics
NPI:1356587034
Name:FORSTER, DAVID
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:FORSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36120 HUFF ROAD
Mailing Address - Street 2:PENDRY ESTATE
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-9335
Mailing Address - Country:US
Mailing Address - Phone:352-357-2268
Mailing Address - Fax:352-357-2268
Practice Address - Street 1:36120 HUFF ROAD
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736-9335
Practice Address - Country:US
Practice Address - Phone:352-357-2268
Practice Address - Fax:352-357-2268
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906206310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility