Healthcare Provider Details

I. General information

NPI: 1346301629
Provider Name (Legal Business Name): FOREVER FAMILY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12010 S WARNER ELLIOT LOOP STE 1
PHOENIX AZ
85044-2731
US

IV. Provider business mailing address

12010 S WARNER ELLIOT LOOP STE 1A
PHOENIX AZ
85044-2731
US

V. Phone/Fax

Practice location:
  • Phone: 480-961-2366
  • Fax: 480-961-2367
Mailing address:
  • Phone: 480-961-2366
  • Fax: 480-961-2367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2959
License Number StateAZ

VIII. Authorized Official

Name: JONNE AMORETTE HOUSH
Title or Position: NURSE PRACTITIONER
Credential: MSN, NP-C
Phone: 480-961-2366