Provider Demographics
NPI:1831464411
Name:FOREVER CARE INC
Entity Type:Organization
Organization Name:FOREVER CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARQUHARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-348-8353
Mailing Address - Street 1:6654 HAWES DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-4631
Mailing Address - Country:US
Mailing Address - Phone:404-348-8353
Mailing Address - Fax:
Practice Address - Street 1:2662 RAINBOW CREEK DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-2155
Practice Address - Country:US
Practice Address - Phone:404-348-8353
Practice Address - Fax:404-973-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACLA000917320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities