Provider Demographics
NPI:1992957542
Name:A FOREVER RECOVERY
Entity type:Organization
Organization Name:A FOREVER RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-788-0496
Mailing Address - Street 1:216 ST MARYS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49017-9710
Mailing Address - Country:US
Mailing Address - Phone:269-799-0496
Mailing Address - Fax:269-964-7932
Practice Address - Street 1:216 ST MARYS LAKE RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49017-9710
Practice Address - Country:US
Practice Address - Phone:269-799-0496
Practice Address - Fax:269-660-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI130102324500000X
MI130123324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility