Forever Grace LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

FOREVER GRACE LLC

Practice address

6 N 88TH Ave
Tolleson, AZ 85353-1318

Phone

(602) 367-9663

NPI assigned

Aug 20, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Azel JacksonNPI 1508415043

Title

Ceo

Phone

(602) 367-9663

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Azel Jackson, LPC

  • Professional Counselor
  • Phoenix, AZ
  • NPI 1508415043
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724112000000",
    "number": "1043043698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 N 88TH AVE",
            "city": "TOLLESON",
            "state": "AZ",
            "postal_code": "853531318",
            "telephone_number": "602-367-9663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 N 88TH AVE",
            "city": "TOLLESON",
            "state": "AZ",
            "postal_code": "853531318",
            "telephone_number": "602-367-9663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREVER GRACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-20",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "AZEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-367-9663",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fami Health Care LLC (Fami Health Care)
• Donald Monti Favre, PHARMACIST
• Sylvia Felix
• Jace Finkbeiner, PHARMD
• First Choice Family Health Center, PLLC
• Lara Ann Freda, ED.S. SCHOOL PSYCH
• Fry's Food and Drug
• Frys
• FSL Programs
• Leslie Ann Fulton, PHARMD

• Adult Mental Health Clinic/Center in Tolleson, AZ
• Providers in Tolleson, AZ by specialty
• Adult Mental Health Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.