Healthcare Provider Details

I. General information

NPI: 1619883386
Provider Name (Legal Business Name): FORWARD PUSH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 CENTRAL ST APT 3
MANCHESTER NH
03103-5277
US

IV. Provider business mailing address

15 SPRUCE ST
FALL RIVER MA
02720-6117
US

V. Phone/Fax

Practice location:
  • Phone: 978-401-1763
  • Fax:
Mailing address:
  • Phone: 978-651-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: ANDRE K BENNETT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHD
Phone: 978-401-1763