Provider Demographics
NPI:1104570696
Name:FOREST PARK NURSING AND REHABILITATION LLC
Entity type:Organization
Organization Name:FOREST PARK NURSING AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YECHIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-744-4611
Mailing Address - Street 1:28 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5654
Mailing Address - Country:US
Mailing Address - Phone:732-744-4611
Mailing Address - Fax:
Practice Address - Street 1:700 WALNUT BOTTOM RD
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3631
Practice Address - Country:US
Practice Address - Phone:717-960-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility