Provider Demographics
NPI:1538847991
Name:FOR 4EVERBLESSED LLC
Entity type:Organization
Organization Name:FOR 4EVERBLESSED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEYANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-392-6934
Mailing Address - Street 1:8747 FONTANA LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2300
Mailing Address - Country:US
Mailing Address - Phone:443-392-6934
Mailing Address - Fax:
Practice Address - Street 1:3605 COURTLEIGH DR
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4806
Practice Address - Country:US
Practice Address - Phone:443-392-6934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251S00000XAgenciesCommunity/Behavioral Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility