=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063220283
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOREVER CARING PERSONAL CARE SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2024
-----------------------------------------------------
Last Update Date | 12/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2179 HIGHWAY 35 S
-----------------------------------------------------
City | FOXWORTH
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39483-3837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-618-5182
-----------------------------------------------------
Fax | 601-618-5183
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 RANKIN CREEK RD
-----------------------------------------------------
City | SANDY HOOK
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39478-9467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-750-3444
-----------------------------------------------------
Fax | 601-819-5183
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | MS. NATASHA NIREE SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 985-750-3444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------