Healthcare Provider Details

I. General information

NPI: 1164315727
Provider Name (Legal Business Name): FAMILY FOREVER SUPPORT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6658 E BENS DR
CAMBY IN
46113-8418
US

IV. Provider business mailing address

6658 E BENS DR
CAMBY IN
46113-8418
US

V. Phone/Fax

Practice location:
  • Phone: 317-441-5998
  • Fax:
Mailing address:
  • Phone: 317-441-5998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: ROBBIN LEIGH AVERY
Title or Position: OWNER
Credential:
Phone: 317-441-5998