MEDICARE: FOREVER COMFORTABLE

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	310400000X	Assisted Living Facility
2	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1962870246
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOREVER COMFORTABLE

Provider Business Mailing Address
First Line	:	PO BOX 24468
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-0168
Country	:	US
Telephone Number	:	610-314-0960
Fax Number	:	610-314-0960

Provider Business Practice Location Address
First Line	:	5504 WESTFORD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-2642
Country	:	US
Telephone Number	:	610-314-0960
Fax Number	:	610-314-0960

Authorized Official
Title or Position	:	CO-OWNER
Name	:	MS. DOROTHY M POLES
Credential	:	BSHS-HEALTHCARE MGMT
Telephone Number	:	610-209-9661

Provider Enumeration Date	:	09/03/2015
Last Update Date	:	09/03/2015

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Directions to “FOREVER COMFORTABLE ” Practice Location

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