Provider Demographics
NPI:1699024448
Name:FOREVER AND A DAY, LLC
Entity type:Organization
Organization Name:FOREVER AND A DAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:504-256-3478
Mailing Address - Street 1:801 N 31ST ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3947
Mailing Address - Country:US
Mailing Address - Phone:318-855-3868
Mailing Address - Fax:
Practice Address - Street 1:801 N 31ST ST STE 2
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3947
Practice Address - Country:US
Practice Address - Phone:318-855-3868
Practice Address - Fax:318-537-9688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPPLIED FOR101YM0800X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty