Organization
MY FOREVER FAMILY GROUP HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISS PEREZ (OWNER)
(239) 450-4516
Entity
Organization
Contact information
Practice address
770 16TH ST SE, NAPLES, FL 34117-9424
(239) 450-4516
Mailing address
770 16TH ST SE, NAPLES, FL 34117-9424
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
376J00000X
Homemaker
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
06/18/2024
Last updated
06/18/2024
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