Provider Demographics
NPI:1518623560
Name:FOREVER LIFE CARE INC
Entity Type:Organization
Organization Name:FOREVER LIFE CARE INC
Other - Org Name:FOREVER LIFE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOEUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:SAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-468-5757
Mailing Address - Street 1:6600 N LINCOLN AVE STE 235
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3627
Mailing Address - Country:US
Mailing Address - Phone:847-468-5757
Mailing Address - Fax:847-724-5030
Practice Address - Street 1:6600 N LINCOLN AVE STE 235
Practice Address - Street 2:
Practice Address - City:LINCOLNWOOD
Practice Address - State:IL
Practice Address - Zip Code:60712-3627
Practice Address - Country:US
Practice Address - Phone:847-468-5757
Practice Address - Fax:847-724-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health