Healthcare Provider Details

I. General information

NPI: 1306770946
Provider Name (Legal Business Name): FOREVER YOUNG ADULT DAYCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2259 MARINER CT
FORT LAUDERDALE FL
33312-5216
US

IV. Provider business mailing address

2259 MARINER CT
FORT LAUDERDALE FL
33312-5216
US

V. Phone/Fax

Practice location:
  • Phone: 201-851-9709
  • Fax: 201-851-9709
Mailing address:
  • Phone: 201-851-9709
  • Fax: 201-851-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIE J DESRAVINES
Title or Position: OWNER
Credential:
Phone: 201-851-9709