Healthcare Provider Details

I. General information

NPI: 1689283186
Provider Name (Legal Business Name): MOVING FORWARD DEVELOPMENTAL CENTER L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S BLACK HORSE PIKE
BLACKWOOD NJ
08012-2955
US

IV. Provider business mailing address

210 S BLACK HORSE PIKE
BLACKWOOD NJ
08012-2955
US

V. Phone/Fax

Practice location:
  • Phone: 856-542-8929
  • Fax:
Mailing address:
  • Phone: 856-542-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEELAN VICTOR
Title or Position: DIRECTOR
Credential:
Phone: 856-542-8929