Organization
FORREST LAKE HEALTH CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS W PENLEY SR. (CEO)
(706) 855-1773
Entity
Organization
Contact information
Practice address
409 PLEASANT HOME RD, AUGUSTA, GA 30907-3523
(706) 863-6033
(706) 863-2661
Mailing address
PO BOX 211529, AUGUSTA, GA 30917-1529
(706) 863-6033
(706) 863-2661
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00142535A
—
GA
01
—
1040940001
DME
—
Enumeration date
08/09/2005
Last updated
08/22/2020
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