MEDICARE: FOREVER HOME

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

General Provider Information

NPI Number	:	1437490976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREVER HOME

Provider Business Mailing Address
First Line	:	1551 JOY RD
Second Line	:
City	:	HARLEM
State	:	GA
Zip	:	30814-4117
Country	:	US
Telephone Number	:	706-466-9930
Fax Number	:

Provider Business Practice Location Address
First Line	:	1551 JOY RD
Second Line	:
City	:	HARLEM
State	:	GA
Zip	:	30814-4117
Country	:	US
Telephone Number	:	706-466-9930
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. MICHAEL ALBERT WEEKS SR.
Credential	:	RN
Telephone Number	:	706-466-9930

Provider Enumeration Date	:	03/07/2013
Last Update Date	:	03/07/2013

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Directions to “FOREVER HOME ” Practice Location

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