Healthcare Provider Details

I. General information

NPI: 1962870246
Provider Name (Legal Business Name): FOREVER COMFORTABLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5504 WESTFORD RD
PHILADELPHIA PA
19120-2642
US

IV. Provider business mailing address

PO BOX 24468
PHILADELPHIA PA
19120-0168
US

V. Phone/Fax

Practice location:
  • Phone: 610-314-0960
  • Fax: 610-314-0960
Mailing address:
  • Phone: 610-314-0960
  • Fax: 610-314-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. DOROTHY M POLES
Title or Position: CO-OWNER
Credential: BSHS-HEALTHCARE MGMT
Phone: 610-209-9661