MEDICARE: FOREVER YOUNG ASSISTED LIVING, 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	:	1396676243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREVER YOUNG ASSISTED LIVING, INC.

Provider Business Mailing Address
First Line	:	3333 S BASCOM AVE
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-7005
Country	:	US
Telephone Number	:	650-559-8301
Fax Number	:	650-559-8301

Provider Business Practice Location Address
First Line	:	1931 WOODSIDE RD
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3336
Country	:	US
Telephone Number	:	650-369-3197
Fax Number	:	650-369-8557

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SKYLAR ARENAS
Credential	:
Telephone Number	:	650-559-8301

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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