Provider Demographics
NPI:1457654253
Name:FOREVER ACTIVE INC
Entity Type:Organization
Organization Name:FOREVER ACTIVE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-389-8790
Mailing Address - Street 1:1 W MOUNTAIN ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3010
Mailing Address - Country:US
Mailing Address - Phone:626-389-8790
Mailing Address - Fax:626-466-3020
Practice Address - Street 1:1 W MOUNTAIN ST UNIT 9
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-3010
Practice Address - Country:US
Practice Address - Phone:626-389-8790
Practice Address - Fax:626-466-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies