Provider Demographics
NPI:1033275755
Name:FOREVER CARE DBA INDEPENDENT OPPORTUNITIES
Entity Type:Organization
Organization Name:FOREVER CARE DBA INDEPENDENT OPPORTUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-877-9209
Mailing Address - Street 1:PO BOX 5067
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40745-5067
Mailing Address - Country:US
Mailing Address - Phone:606-877-9209
Mailing Address - Fax:606-877-1770
Practice Address - Street 1:400 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1909
Practice Address - Country:US
Practice Address - Phone:606-877-9209
Practice Address - Fax:606-877-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY320600000X, 320800000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100008760Medicaid
KY33900788Medicaid
KY7100035380Medicaid