# FOREVER HOME, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619485851
- **Authorized official:** DR. KATHLEEN ANN SUBASIC PHD, OTR/L, CPAS (OCCUPATIONAL THERAPIST)
- **Authorized official phone:** (410) 812-1916

## Contact information

- **Practice address:** 1324 RAYVILLE RD, PARKTON, MD 21120-9056
- **Practice address phone:** (443) 212-5340
- **Mailing address:** PO BOX 652, MONKTON, MD 21111-0652
- **Mailing address phone:** (410) 812-1916

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225XE0001X | Environmental Modification Occupational Therapist | 04200 | MD | Yes |

## Other

- **Enumeration date:** 01/22/2018
- **Last updated:** 01/22/2018