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General NPI Number Information
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NPI Number | 1043773633
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Entity Type | Organization
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Legal Business Name | FOREVER CARE SUPPORTS COORDINATION LLC
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 04/10/2019
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Provider Practice Location Address
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Address Line | 1706 N 2ND ST # R5
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City | PHILADELPHIA
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State | PA
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Zip | 19122-3110
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Country | US
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Telephone | 267-340-2556
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Fax |
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Provider Business Mailing Address
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Address Line | 232 BARTLETT AVE
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City | SHARON HILL
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State | PA
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Zip | 19079-1304
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Country | US
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Telephone | 267-340-2556
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. TODD UNTHANK-MAY JR.
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Credential |
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Telephone | 267-340-2556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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