Healthcare Provider Details

I. General information

NPI: 1871016691
Provider Name (Legal Business Name): MOVING FORWARD RESIDENTIAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2017
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7175 STATE ROUTE 104
MC DERMOTT OH
45652-8888
US

IV. Provider business mailing address

PO BOX 402
WHEELERSBURG OH
45694-0402
US

V. Phone/Fax

Practice location:
  • Phone: 740-858-6683
  • Fax:
Mailing address:
  • Phone: 740-357-1937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHELE LAWSON
Title or Position: OWNER
Credential:
Phone: 740-357-1937