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General NPI Number Information
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NPI Number | 1952776676
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Entity Type | Organization
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Legal Business Name | FOREVER YOURS SUPPORT COORDINATION AGENCY
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Dates
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Enumeration Date | 12/07/2015
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Last Update Date | 12/07/2015
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Provider Practice Location Address
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Address Line | 1390 INDUSTRIAL BLVD SUITE 4
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-4034
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Country | US
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Telephone | 267-538-8610
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Fax |
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Provider Business Mailing Address
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Address Line | 1390 INDUSTRIAL BLVD SUITE 4
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City | SOUTHAMPTON
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State | PA
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Zip | 18966-4034
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Country | US
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Telephone | 267-538-8610
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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. DANIEL GORBERG
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Credential |
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Telephone | 267-538-8610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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