Healthcare Provider Details

I. General information

NPI: 1043773633
Provider Name (Legal Business Name): FOREVER CARE SUPPORTS COORDINATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 N 2ND ST # R5
PHILADELPHIA PA
19122-3110
US

IV. Provider business mailing address

232 BARTLETT AVE
SHARON HILL PA
19079-1304
US

V. Phone/Fax

Practice location:
  • Phone: 267-340-2556
  • Fax:
Mailing address:
  • Phone: 267-340-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MR. TODD UNTHANK-MAY JR.
Title or Position: OWNER
Credential:
Phone: 267-340-2556