Healthcare Provider Details

I. General information

NPI: 1669980199
Provider Name (Legal Business Name): FOREVER LIFE HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 NW 79TH AVE STE 223
DORAL FL
33166-6546
US

IV. Provider business mailing address

3900 NW 79TH AVE STE 223
DORAL FL
33166-6546
US

V. Phone/Fax

Practice location:
  • Phone: 786-955-5117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MIRIAM RINCON
Title or Position: AP
Credential: RBT
Phone: 786-406-5380