Organization
FOREVER PLACE BEHAVIORAL LLC
Active
Parent organization
FOREVER PLACE LLC
Other names
Forever Place Behavioral LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOREVER PLACE LLC
Authorized official
LACHONIQUIE KIERRA EVANS RN (OWNER)
(567) 225-4008
Entity
Organization
Contact information
Practice address
2356 N SAND HILLS CT, CASA GRANDE, AZ 85122-6664
(567) 225-4008
Mailing address
2400 N BULLARD AVE APT 2009, GOODYEAR, AZ 85395-3305
(567) 225-4008
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356948954
—
AZ
Enumeration date
01/31/2022
Last updated
01/31/2022
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