Healthcare Provider Details

I. General information

NPI: 1124968045
Provider Name (Legal Business Name): FOREVER HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4806 69TH AVE N
BROOKLYN CENTER MN
55429-1673
US

IV. Provider business mailing address

4806 69TH AVE N
BROOKLYN CENTER MN
55429-1673
US

V. Phone/Fax

Practice location:
  • Phone: 763-777-5468
  • Fax:
Mailing address:
  • Phone: 763-777-5468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JELILI OWOLABI DURODOLA
Title or Position: OWNER
Credential:
Phone: 763-227-9706