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General NPI Number Information
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NPI Number | 1770724494
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Entity Type | Organization
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Legal Business Name | MARY E.FOREVER CARE,INCORPORATED
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Dates
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Enumeration Date | 03/09/2009
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Last Update Date | 03/09/2009
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Provider Practice Location Address
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Address Line | 25835 NARBONNE AVE SUITE-280E
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City | LOMITA
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State | CA
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Zip | 90717-3074
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Country | US
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Telephone | 310-891-6092
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Fax |
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Provider Business Mailing Address
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Address Line | 25835 NARBONNE AVE SUITE-280E
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City | LOMITA
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State | CA
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Zip | 90717-3074
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Country | US
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Telephone | 310-891-6092
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. LARONDA CHERI SMITH
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Credential |
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Telephone | 562-781-3711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 3044174
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License Number State | CA
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