Healthcare Provider Details

I. General information

NPI: 1013604305
Provider Name (Legal Business Name): FOREVER YOUNG ADULT DAY HEALTH CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MILTON ST
DEDHAM MA
02026-2915
US

IV. Provider business mailing address

60 MILTON ST
DEDHAM MA
02026-2915
US

V. Phone/Fax

Practice location:
  • Phone: 781-408-2107
  • Fax:
Mailing address:
  • Phone:
  • 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: BERES ST JULIEN
Title or Position: OWNER
Credential:
Phone: 781-408-2107