MEDICARE: FOREVER WORTHY 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1801475199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREVER WORTHY LLC

Provider Business Mailing Address
First Line	:	1803 S 92ND ST APT 107
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-4288
Country	:	US
Telephone Number	:	414-306-1059
Fax Number	:

Provider Business Practice Location Address
First Line	:	1803 S 92ND ST APT 107
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53214-4288
Country	:	US
Telephone Number	:	414-306-1059
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MISS SHAKAYLA DIMITRIONA ANDERSON
Credential	:
Telephone Number	:	414-306-1059

Provider Enumeration Date	:	04/05/2021
Last Update Date	:	04/05/2021

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Directions to “FOREVER WORTHY LLC ” Practice Location

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