Provider Demographics
NPI:1083110043
Name:FOREVER HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:FOREVER HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MA
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-897-4352
Mailing Address - Street 1:8532 W CAPITOL DR STE L103
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1850
Mailing Address - Country:US
Mailing Address - Phone:414-226-5482
Mailing Address - Fax:414-226-5511
Practice Address - Street 1:8532 W. CAPITOL DR.
Practice Address - Street 2:STE. L103
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222
Practice Address - Country:US
Practice Address - Phone:414-226-5482
Practice Address - Fax:414-226-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100081084Medicaid