Healthcare Provider Details

I. General information

NPI: 1710415302
Provider Name (Legal Business Name): FORWARD LIVING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 NYALA DR
COLORADO SPRINGS CO
80922-2436
US

IV. Provider business mailing address

4102 NYALA DR
COLORADO SPRINGS CO
80922-2436
US

V. Phone/Fax

Practice location:
  • Phone: 719-460-7629
  • Fax:
Mailing address:
  • Phone: 719-460-7629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LAPIOLI
Title or Position: CEO
Credential:
Phone: 719-460-7629