MEDICARE: A FOREVER RECOVERY

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	324500000X	Substance Abuse Rehabilitation Facility	130123	MI
2	324500000X	Substance Abuse Rehabilitation Facility	130102	MI

General Provider Information

NPI Number	:	1992957542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A FOREVER RECOVERY

Provider Business Mailing Address
First Line	:	216 ST MARYS LAKE RD
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-9710
Country	:	US
Telephone Number	:	269-799-0496
Fax Number	:	269-964-7932

Provider Business Practice Location Address
First Line	:	216 ST MARYS LAKE RD
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-9710
Country	:	US
Telephone Number	:	269-799-0496
Fax Number	:	269-660-1923

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. PAMELA ANDERSON
Credential	:
Telephone Number	:	269-788-0496

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	09/01/2015

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Directions to “A FOREVER RECOVERY ” Practice Location

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