NPIMap

Organization Active NPI

Forever Place LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Goodyear, AZ
National Provider Identifier
1356948954
Registry record updated Oct 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
Legal business name
FOREVER PLACE LLC
Practice address
4200 N Pebble Creek Pkwy Apt 2069
Goodyear, AZ 85395-9028
Phone
(567) 225-4008
NPI assigned
Oct 6, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2020

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

Authorized official

Name
Ms. Lachoniquie Evans
Title
Owner/Director
Phone
(567) 225-4008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Primary

Addresses

Primary practice location

4200 N Pebble Creek Pkwy Apt 2069
Goodyear, AZ 85395-9028

Mailing address

4200 N Pebble Creek Pkwy Apt 2069
Goodyear, AZ 85395-9028
Phone (567) 225-4008

National Provider Directory

National Provider Directory
Tax ID family
Forever Place LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601942400000",
    "number": "1356948954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 N PEBBLE CREEK PKWY APT 2069",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853959028",
            "telephone_number": "567-225-4008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 N PEBBLE CREEK PKWY APT 2069",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853959028",
            "telephone_number": "567-225-4008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREVER PLACE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-06",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "LACHONIQUIE",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "567-225-4008",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; 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.