Healthcare Provider Details

I. General information

NPI: 1588258206
Provider Name (Legal Business Name): FOREVER YOUNG INTERNATIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 LITHIA PINECREST RD STE H
BRANDON FL
33511-5300
US

IV. Provider business mailing address

3848 SUN CITY CENTER BLVD # 104-49
SUN CITY CENTER FL
33573-6843
US

V. Phone/Fax

Practice location:
  • Phone: 813-815-4776
  • Fax: 813-441-8311
Mailing address:
  • Phone: 813-815-4776
  • Fax: 813-441-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ZARANDA YOUNG
Title or Position: OWNER
Credential:
Phone: 813-857-8556