Organization
FOREVER PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LACHONIQUIE EVANS (OWNER/DIRECTOR)
(567) 225-4008
Entity
Organization
Contact information
Practice address
4200 N PEBBLE CREEK PKWY APT 2069, GOODYEAR, AZ 85395-9028
(567) 225-4008
Mailing address
4200 N PEBBLE CREEK PKWY APT 2069, GOODYEAR, AZ 85395-9028
(567) 225-4008
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/06/2020
Last updated
10/06/2020
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