Healthcare Provider Details

I. General information

NPI: 1396676243
Provider Name (Legal Business Name): FOREVER YOUNG ASSISTED LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 WOODSIDE RD
REDWOOD CITY CA
94061-3336
US

IV. Provider business mailing address

3333 S BASCOM AVE
CAMPBELL CA
95008-7005
US

V. Phone/Fax

Practice location:
  • Phone: 650-369-3197
  • Fax: 650-369-8557
Mailing address:
  • Phone: 650-559-8301
  • Fax: 408-559-7089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: SKYLAR ARENAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 650-559-8301