Healthcare Provider Details

I. General information

NPI: 1477005759
Provider Name (Legal Business Name): FOREVER ANGELS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 ACADEMY AVE
WAYNESBORO GA
30830-1269
US

IV. Provider business mailing address

831 ACADEMY AVE
WAYNESBORO GA
30830-1269
US

V. Phone/Fax

Practice location:
  • Phone: 706-554-9379
  • Fax:
Mailing address:
  • Phone: 706-554-9379
  • Fax:

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: JUNE JOHNSON
Title or Position: CEO
Credential:
Phone: 706-554-9379