Provider Demographics
NPI:1477313351
Name:FOREVERSONYA LLC
Entity Type:Organization
Organization Name:FOREVERSONYA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSEE
Authorized Official - Prefix:
Authorized Official - First Name:YOUSEF
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKHOURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-737-9457
Mailing Address - Street 1:6552 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3752
Mailing Address - Country:US
Mailing Address - Phone:714-737-9457
Mailing Address - Fax:
Practice Address - Street 1:11602 GARDEN DR
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-1555
Practice Address - Country:US
Practice Address - Phone:714-737-9457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility