# FOREST LANE HEALTHCARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447007638
- **Authorized official:** DAMOYA DAVIS (CEO)
- **Authorized official phone:** (904) 445-0261

## Contact information

- **Practice address:** 1616 CONCIERGE BLVD STE 103, DAYTONA BEACH, FL 32117-7159
- **Practice address phone:** (386) 271-2753
- **Mailing address:** 818 FOREST LN, DAYTONA BEACH, FL 32114-1916
- **Mailing address phone:** (904) 445-0261

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WH0200X | Home Health Registered Nurse | — | NULL | — |
| 251E00000X | Home Health Agency | — | NULL | Yes |
| 251F00000X | Home Infusion Agency | — | NULL | — |
| 251G00000X | Community Based Hospice Care Agency | — | NULL | — |
| 251J00000X | Nursing Care Agency | — | NULL | — |
| 332U00000X | Home Delivered Meals | — | NULL | — |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |
| 347C00000X | Private Vehicle | — | NULL | — |
| 376K00000X | Nurse's Aide | — | NULL | — |

## Other

- **Enumeration date:** 05/04/2024
- **Last updated:** 05/04/2024