Provider Demographics
NPI:1245584150
Name:A FOREVER RECOVERY
Entity Type:Organization
Organization Name:A FOREVER RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PER
Authorized Official - Middle Name:
Authorized Official - Last Name:WICKSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-218-4406
Mailing Address - Street 1:216 ST MARYS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-9710
Mailing Address - Country:US
Mailing Address - Phone:888-887-9486
Mailing Address - Fax:
Practice Address - Street 1:163 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-3426
Practice Address - Country:US
Practice Address - Phone:888-887-9486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI130115324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility