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General NPI Number Information
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NPI Number | 1083478374
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Entity Type | Organization
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Legal Business Name | FAITH FORWARD PSYCHIATRY LLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 7900 INTERNATIONAL DR STE 300-7007
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City | BLOOMINGTON
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State | MN
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Zip | 55425-1510
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Country | US
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Telephone | 715-222-5958
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Fax |
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Provider Business Mailing Address
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Address Line | 1429 MAGEE CT
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City | LITTLE RIVER
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State | SC
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Zip | 29566-5927
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Country | US
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Telephone | 715-222-5958
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | MS. CASSIE RENEE RIDER
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Credential | PMHNP-BC
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Telephone | 715-222-5958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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