| NPI | 1225792070 |
|---|---|
| Doing Business As | FOREST GLADE HOME |
| Doing Business As | FOREST GLADE |
| Entity Type | Organization |
| Authorized Contact | JEFFREY ENGELKE President 512-916-1632 |
| Organization Subpart ? | No |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2021-10-27 |