MEDICARE: FRIENDS FOREVER, LLC

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	251E00000X	Home Health Agency	000315500	FL

General Provider Information

NPI Number	:	1417316621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRIENDS FOREVER, LLC

Provider Business Mailing Address
First Line	:	4241 SW HAGAPLAN ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-6583
Country	:	US
Telephone Number	:	772-224-4466
Fax Number	:

Provider Business Practice Location Address
First Line	:	4241 SW HAGAPLAN ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34953-6583
Country	:	US
Telephone Number	:	772-224-4466
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MARLENE Y SAMUELS
Credential	:
Telephone Number	:	772-224-4466

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	02/16/2016

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