Healthcare Provider Details

I. General information

NPI: 1073245163
Provider Name (Legal Business Name): FAMILY FOREVER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5042 GERMANTOWN AVENUE 1ST FLOOR
PHILADELPHIA PA
19144-5948
US

IV. Provider business mailing address

134 COUNTRY CLUB DR
LANSDALE PA
19446-1456
US

V. Phone/Fax

Practice location:
  • Phone: 267-209-2019
  • Fax:
Mailing address:
  • Phone: 267-209-2019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. NATASHA J WATSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 267-209-2019