Basic Information
| Provider Information | |||||||||
| NPI: | 1912488693 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FORESTVIEW OPCO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3009 QUENTIN RD | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112344246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189423483 | ||||||||
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| Practice Location | |||||||||
| Address1: | 323 FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454054599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372240793 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2018 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | FREUND | ||||||||
| AuthorizedOfficialFirstName: | NATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7189423483 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | LNHA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.