Provider Demographics
NPI:1619014073
Name:FOREVER YOUNG GROUP CARE, LLC
Entity Type:Organization
Organization Name:FOREVER YOUNG GROUP CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:WESTON
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:910-527-0258
Mailing Address - Street 1:1133 CHESTNUT WOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1890
Mailing Address - Country:US
Mailing Address - Phone:910-527-0258
Mailing Address - Fax:910-864-2548
Practice Address - Street 1:975 COMET CIR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0400
Practice Address - Country:US
Practice Address - Phone:910-527-0258
Practice Address - Fax:910-864-2548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL026678320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603934Medicaid