MEDICARE: FOREVER HOME LIVING CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1245521855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREVER HOME LIVING CENTER INC

Provider Business Mailing Address
First Line	:	16710 COLD HARBOR LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-7206
Country	:	US
Telephone Number	:	281-313-0896
Fax Number	:	281-313-0898

Provider Business Practice Location Address
First Line	:	1601 INDUSTRIAL BLVD STE 3040
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-2602
Country	:	US
Telephone Number	:	281-313-0896
Fax Number	:	281-313-0898

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MISS ALABA JACOB
Credential	:	RN
Telephone Number	:	281-313-0896

Provider Enumeration Date	:	04/29/2011
Last Update Date	:	10/24/2022

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