Organization
FOREVERMORE MIND BODY & SOUL
Active
Other names
Forevermore Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEMITRIUS BRACKETT PAIN (MENTAL HEALTH PROVIDER)
(815) 766-5999
Entity
Organization
Contact information
Practice address
411 N BLUFF ST APT 11, JOLIET, IL 60435-7295
(815) 766-5999
Mailing address
411 N BLUFF ST APT 11, JOLIET, IL 60435-7295
(815) 766-5999
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QC1500X
Community Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP3300X
Pain Clinic/Center
—
—
261QR1100X
Research Clinic/Center
—
—
Other
Enumeration date
08/29/2023
Last updated
12/03/2025
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