Healthcare Provider Details

I. General information

NPI: 1396613022
Provider Name (Legal Business Name): FOREVER CARING WELLNESS & LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2025
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 ONVILLE RD STE 101D-11
STAFFORD VA
22556-3831
US

IV. Provider business mailing address

24 ONVILLE RD STE 101D-11
STAFFORD VA
22556-3831
US

V. Phone/Fax

Practice location:
  • Phone: 540-768-9454
  • Fax: 919-925-6440
Mailing address:
  • Phone: 540-768-9454
  • Fax: 919-925-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PHANTA JAH
Title or Position: NP
Credential: AGPCNP
Phone: 540-768-9454