Healthcare Provider Details

I. General information

NPI: 1316779465
Provider Name (Legal Business Name): FORGE AHEAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N STEPHANIE ST STE 110
HENDERSON NV
89014-8771
US

IV. Provider business mailing address

7536 MOUNT SPOKANE CT
LAS VEGAS NV
89113-5376
US

V. Phone/Fax

Practice location:
  • Phone: 702-723-4774
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: VONZELLA JENKINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 702-723-4774