Provider Demographics
NPI:1457758278
Name:FOREVER STRONG
Entity Type:Organization
Organization Name:FOREVER STRONG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-778-9908
Mailing Address - Street 1:1014 S DUNCAN RD
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-4040
Mailing Address - Country:US
Mailing Address - Phone:217-778-9908
Mailing Address - Fax:
Practice Address - Street 1:1014 S DUNCAN RD
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-4040
Practice Address - Country:US
Practice Address - Phone:217-778-9908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251E0000X251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health