Forest Avenue Opco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

FOREST AVENUE OPCO, LLC

Doing business as

Pine Forest Health and Rehabilitation

Practice address

1116 Forest Ave
Jackson, MS 39206-3216

Phone

(601) 366-6461

Fax

(601) 362-4041

NPI assigned

Nov 6, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Thomas Fick

Title

Chief Financial Officer

Phone

(615) 250-7100

Specialties & licenses 1

Addresses

Other names 1

• Pine Forest Health and Rehabilitation Doing business as

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Skilled nursing facility certification: CCN 255326

Legal name

FOREST AVENUE OPCO, LLC

Doing business as

PINE FOREST HEALTH AND REHABILITATION

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jun 1, 2008

Last certification

Dec 5, 2023

Beds

120

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Enrollment address

1116 Forest Avenue
Jackson, MS 39206-3216

Nursing home name

PINE FOREST HEALTH AND REHABILITATION

Affiliated entity

VANGUARD HEALTHCARE

Listed as

Pine Forest Health and RehabilitationCCN 255326 · All quality measures

Overall star rating

1 of 5

Health inspections

1 of 5

Staffing

2 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jun 1, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

12097.8 residents per day on average

Chain

Vanguard Healthcare6 facilities in the chain

Abuse citation

Cited for abuse (Care Compare abuse icon)

Penalties (3 years)

8Fines totaling $136,799

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy Duncan Estes, M.D.

  • General Practice Physician
  • Jackson, MS
  • NPI 1285746511
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Timothy Duncan Estes, M.D.

  • General Practice Physician
  • Jackson, MS
  • NPI 1285746511

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541462400000",
    "number": "1396213492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9020 OVERLOOK BLVD STE 202",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370272755",
            "telephone_number": "615-250-7100",
            "fax_number": "615-250-7101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 FOREST AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392063216",
            "telephone_number": "601-366-6461",
            "fax_number": "601-362-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST AVENUE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-06",
        "last_updated": "2018-11-06",
        "status": "A",
        "authorized_official_last_name": "FICK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "615-250-7100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Forest Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Victor John Ford III, M.D.
• Jessica Renee Fordham, NP
• Shonvonyae Fordham
• Cali Foreman, LPC
• Jennifer Nichols Foreman, A-GNP-C
• Forest Hill Nursing Center, Inc.
• Ashley Lynne Forester, M.ED
• Tamika Forkner, RD, LD
• Thomas P Forks, DO
• Akeelein Forrest

• Skilled Nursing Facility in Jackson, MS
• Providers in Jackson, MS by specialty
• Skilled Nursing Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.