Provider Demographics
NPI:1366653537
Name:FORREST MANOR RESIDENTIAL CARE FACILITY
Entity type:Organization
Organization Name:FORREST MANOR RESIDENTIAL CARE FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-673-4383
Mailing Address - Street 1:420 W HURON ST
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-2806
Mailing Address - Country:US
Mailing Address - Phone:870-673-4383
Mailing Address - Fax:870-673-4383
Practice Address - Street 1:420 W HURON ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-2806
Practice Address - Country:US
Practice Address - Phone:870-830-6026
Practice Address - Fax:870-673-4383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR434310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility