Provider Demographics
NPI:1043773633
Name:FOREVER CARE SUPPORTS COORDINATION LLC
Entity Type:Organization
Organization Name:FOREVER CARE SUPPORTS COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:UNTHANK-MAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:267-340-2556
Mailing Address - Street 1:232 BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19079-1304
Mailing Address - Country:US
Mailing Address - Phone:267-340-2556
Mailing Address - Fax:
Practice Address - Street 1:1706 N 2ND ST # R5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-3110
Practice Address - Country:US
Practice Address - Phone:267-340-2556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No174200000XOther Service ProvidersMeals
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30811614Medicaid