Healthcare Provider Details

I. General information

NPI: 1861006660
Provider Name (Legal Business Name): FOREVER FAMILY HOMECARE AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2020
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 LANSING ST
PHILADELPHIA PA
19136-3034
US

IV. Provider business mailing address

3402 LANSING ST
PHILADELPHIA PA
19136-3034
US

V. Phone/Fax

Practice location:
  • Phone: 267-496-2227
  • Fax:
Mailing address:
  • Phone: 267-496-2227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CHARHONDA WALLACE
Title or Position: ADMINISTRATOR
Credential:
Phone: 267-496-2227