Basic Information
| Provider Information | |||||||||
| NPI: | 1699769828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOREST PARK HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1217 SLATE HILL RD | ||||||||
| Address2: | |||||||||
| City: | CAMP HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170118012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173034926 | ||||||||
| FaxNumber: | 7177376763 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 WALNUT BOTTOM RD | ||||||||
| Address2: | |||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170133631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7173034926 | ||||||||
| FaxNumber: | 7177376763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HEARN | ||||||||
| AuthorizedOfficialFirstName: | GARRIANN | ||||||||
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| AuthorizedOfficialTitleorPosition: | AR MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7173034926 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 60802 | PA | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 1007494880003 | 05 | PA | MEDICAID |