Healthcare Provider Details

I. General information

NPI: 1033275755
Provider Name (Legal Business Name): FOREVER CARE DBA INDEPENDENT OPPORTUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S MAIN ST SUITE 200
LONDON KY
40741-1909
US

IV. Provider business mailing address

PO BOX 5067
LONDON KY
40745-5067
US

V. Phone/Fax

Practice location:
  • Phone: 606-877-9209
  • Fax: 606-877-1770
Mailing address:
  • Phone: 606-877-9209
  • Fax: 606-877-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateKY

VIII. Authorized Official

Name: MR. WAYNE H. HARVEY
Title or Position: CHIEF OPPERATIONS OFFICER
Credential:
Phone: 606-877-9209