Provider Demographics
NPI:1770724494
Name:MARY E.FOREVER CARE,INCORPORATED
Entity type:Organization
Organization Name:MARY E.FOREVER CARE,INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LARONDA
Authorized Official - Middle Name:CHERI
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-781-3711
Mailing Address - Street 1:25835 NARBONNE AVE
Mailing Address - Street 2:SUITE-280E
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-3074
Mailing Address - Country:US
Mailing Address - Phone:310-891-6092
Mailing Address - Fax:
Practice Address - Street 1:25835 NARBONNE AVE
Practice Address - Street 2:SUITE-280E
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3074
Practice Address - Country:US
Practice Address - Phone:310-891-6092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3044174253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care