Provider Demographics
NPI:1316652332
Name:FERVENT CARE SERVICES LLC
Entity type:Organization
Organization Name:FERVENT CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUCKY
Authorized Official - Middle Name:IDA
Authorized Official - Last Name:IGBINOBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-723-1475
Mailing Address - Street 1:4225 E UNIVERSITY DR APT 107
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-7092
Mailing Address - Country:US
Mailing Address - Phone:763-923-1475
Mailing Address - Fax:
Practice Address - Street 1:4225 E UNIVERSITY DR APT 107
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-7092
Practice Address - Country:US
Practice Address - Phone:763-923-1475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No385H00000XRespite Care FacilityRespite Care