MEDICARE: FOREVER US SOCIAL ADULT DAY CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1043959414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREVER US SOCIAL ADULT DAY CARE, INC

Provider Business Mailing Address
First Line	:	80 BRUCKNER BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-4492
Country	:	US
Telephone Number	:	917-891-8753
Fax Number	:	347-391-2112

Provider Business Practice Location Address
First Line	:	80 BRUCKNER BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10454-4492
Country	:	US
Telephone Number	:	917-891-8753
Fax Number	:	347-391-2112

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MR. GENE BENFELD
Credential	:
Telephone Number	:	917-891-8753

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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