FOREVER PLACE LLC


Address: 4200 N Pebble Creek Pkwy Apt 2069, Goodyear, AZ 85395-9028
Phone: 5672254008

FOREVER PLACE LLC (NPI# 1356948954) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1356948954
Entity Type Organization
Organization Name FOREVER PLACE LLC
Practice Address 4200 N Pebble Creek Pkwy Apt 2069
Goodyear
AZ 85395-9028
Practice Telephone 5672254008
Mailing Telephone 5672254008
Enumeration Date 2020-10-06
Last Update Date 2020-10-06
Authorized Official Name MS. LACHONIQUIE EVANS (OWNER/DIRECTOR)
Authorized Official Telephone 5672254008
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 320900000X Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities Residential Treatment Facilities

Office Location

Street Address 4200 N PEBBLE CREEK PKWY APT 2069
City GOODYEAR
State AZ
Zip Code 85395-9028

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1154962439 Amber Dawn Gutierrez Registered Nurse 15430 W. Turney Avenue, Goodyear, AZ 85395 2019-10-08
1851947865 Az Care Partners Home Care, LLC Chore Provider 14122 W. Mcdowell Rd., Suite 102a, Goodyear, AZ 85395 2019-08-15
1407334329 Hana M Eichele Occupational Therapist 13385 W Mcdowell Road, Goodyear, AZ 85395 2018-08-02
1639662406 Kristen Henderson Occupational Therapist 14577 W Indian School Road, Goodyear, AZ 85395 2018-06-07
1114419389 Eric Seabaugh Specialist/Technologist 13385 W. Mcdowell Rd., Goodyear, AZ 85395 2018-06-04
1912497504 Goodyear Modern Dentistry, LLP Dentist 15260 West Mcdowell Rd, Goodyear, AZ 85395 2018-05-18
1225531551 Erik Jason Martinez Registered Nurse 4565 N 153rd Ln, Goodyear, AZ 85395 2018-03-13
1538677042 Kacie Bartlett Speech-Language Pathologist 14557 W Mcdowel Rd, Suiet 500, Goodyear, AZ 85395 2018-01-18
1942717277 Deeann Guymon Specialist/Technologist 13385 W. Mcdowell Road, Goodyear, AZ 85395 2018-01-09
1023520228 Kathy Lynn Gorchesky Registered Nurse 15430 West Turney Avenue, Goodyear, AZ 85395 2017-10-27
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Taxonomy Information

Taxonomy Code 320900000X
Grouping Residential Treatment Facilities
Classification Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities

Taxonomy Definition

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.
Notes: [7/1/2003: new]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1972141422 Av Care Agency LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 2267 S 173rd Dr, Goodyear, AZ 85338-1961 2019-12-16
1659719995 Arizona Behavioral Care Homes Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 560 N 159th Ln, Goodyear, AZ 85338-3276 2013-06-10

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1285245407 Ams Living, LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 3058 E Nance St, Mesa, AZ 85213-1644 2020-08-11
1437768892 Max Care Center LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 2239 W Hasan Dr, Phoenix, AZ 85041-5312 2020-07-30
1265050876 Arizona Alternative Support, LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 36379 W El Greco St, Maricopa, AZ 85138-5323 2020-07-09
1255957304 Benchmark Valley LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 7209 W Forest Grove Ave, Phoenix, AZ 85043-7303 2020-06-24
1265067052 Benchmark Valley LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 7321 S 15th Dr, Phoenix, AZ 85041-6932 2020-03-12
1083249874 Benchmark Valley LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 1506 E Irwin Ave, Phoenix, AZ 85042-5618 2020-03-12
1861024069 New Roots Residency LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 3139 W Carson Rd, Phoenix, AZ 85041-6342 2020-02-06
1972149078 Serenitybehavioralhealth.llc Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 15202 N Flamenco Dr, Phoenix, AZ 85053-4872 2019-11-23
1952945370 Natalie Miranda Contreras Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 5717 S Southland Blvd Apt D, Tucson, AZ 85706-4241 2019-10-29
1386102788 Huduma House, LLC Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities 6221 W Illini St, Phoenix, AZ 85043-1915 2019-03-05
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Competitor

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City GOODYEAR
Zip Code 85395

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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