Healthcare Provider Details

I. General information

NPI: 1467135699
Provider Name (Legal Business Name): THE FORGOTTEN WAR, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 E ASCENSION ST # 861
GONZALES LA
70737-3028
US

IV. Provider business mailing address

1640 ROYAL TROON CT
ZACHARY LA
70791-5452
US

V. Phone/Fax

Practice location:
  • Phone: 225-286-9748
  • Fax:
Mailing address:
  • Phone: 225-772-8499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. KIA PRICE
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 225-772-8499