Healthcare Provider Details

I. General information

NPI: 1104762707
Provider Name (Legal Business Name): FOREVER GRACE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3108 MIDWAY RD
PLANT CITY FL
33565-2310
US

IV. Provider business mailing address

3108 MIDWAY RD
PLANT CITY FL
33565-2310
US

V. Phone/Fax

Practice location:
  • Phone: 813-316-5625
  • Fax:
Mailing address:
  • Phone: 813-316-5625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DAUGERH LOPEZ LORENZO
Title or Position: CEO
Credential: CEO
Phone: 813-316-5625