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General NPI Number Information
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NPI Number | 1104762707
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Entity Type | Organization
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Legal Business Name | FOREVER GRACE SERVICES LLC
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Dates
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Enumeration Date | 04/27/2026
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Last Update Date | 04/27/2026
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Provider Practice Location Address
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Address Line | 3108 MIDWAY RD
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City | PLANT CITY
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State | FL
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Zip | 33565-2310
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Country | US
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Telephone | 813-316-5625
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Fax |
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Provider Business Mailing Address
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Address Line | 3108 MIDWAY RD
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City | PLANT CITY
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State | FL
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Zip | 33565-2310
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Country | US
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Telephone | 813-316-5625
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DAUGERH LOPEZ LORENZO
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Credential | CEO
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Telephone | 813-316-5625
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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