Forever Place Behavioral LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

FOREVER PLACE BEHAVIORAL LLC

Practice address

2356 N Sand Hills CT
Casa Grande, AZ 85122-6664

Phone

(567) 225-4008

NPI assigned

Jan 31, 2022

Organization subpart

Yes

Parent organization

FOREVER PLACE LLCAs reported in NPPES

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

Authorized official

Name

Lachoniquie Kierra Evans, RN

Title

Owner

Phone

(567) 225-4008

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Forever Place Behavioral LLC Doing business as

Tax ID family

Forever Place LLC2 organizations share this tax ID, including this one

Part of

Forever Place LLC

Other organizations with this tax ID 1

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

• Forever Place LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Goodyear, AZ
  • NPI 1356948954
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Forever Place LLC

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Goodyear, AZ
  • NPI 1356948954
  NPPES parent name

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

{
    "created_epoch": "1643587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643587200000",
    "number": "1376296202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 N BULLARD AVE APT 2009",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853953305",
            "telephone_number": "567-225-4008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2356 N SAND HILLS CT",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851226664",
            "telephone_number": "567-225-4008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREVER PLACE BEHAVIORAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOREVER PLACE LLC",
        "enumeration_date": "2022-01-31",
        "last_updated": "2022-01-31",
        "certification_date": "2022-01-31",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "LACHONIQUIE",
        "authorized_official_middle_name": "KIERRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "567-225-4008",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356948954",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Forever Place Behavioral LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Florence Oladokun PLLC
• Alberto Salazar Flores Jr., SLPA
• Danielle Ashley Florio, RN
• Franklin Fonutchi
• Jay D Ford, FNP
• Mehdi Foroogozar, HAD
• Darrin N Forsyth, CEP
• Nicholetta Fortunato-Tamayo, OTR/L
• Claude Carl Fosdick, M.D.
• Dawn M Franklin, PHARM.D.

• Mental Illness Community Based Residential Treatment Facility in Casa Grande, AZ
• Providers in Casa Grande, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2022; 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.