MEDICARE: FOREVER LIFE 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	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1518623560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREVER LIFE CARE INC

Provider Business Mailing Address
First Line	:	6600 N LINCOLN AVE STE 235
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-3627
Country	:	US
Telephone Number	:	847-468-5757
Fax Number	:	847-724-5030

Provider Business Practice Location Address
First Line	:	6600 N LINCOLN AVE STE 235
Second Line	:
City	:	LINCOLNWOOD
State	:	IL
Zip	:	60712-3627
Country	:	US
Telephone Number	:	847-468-5757
Fax Number	:	847-724-5030

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SOEUNG SAN
Credential	:
Telephone Number	:	847-468-5757

Provider Enumeration Date	:	11/15/2021
Last Update Date	:	06/07/2022

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Directions to “FOREVER LIFE CARE INC ” Practice Location

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