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1295667533 NPI number — FORWARD BOUND LLC

NPI Number: 1295667533
Health Care Provider/Practitioner: FORWARD BOUND LLC

Information about “1295667533” NPI (FORWARD BOUND LLC) exists in 1295667533 in HTML format HTML  |  1295667533 in plain Text format TXT  |  1295667533 in PDF (Portable Document Format) PDF  |  1295667533 in an XML format XML  formats.

NPI Number : 1295667533 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295667533",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "FORWARD BOUND LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5 TIMBERLANE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORTH EAST",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21901-4425",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "302-333-7320",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "202 BOXWOOD RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WILMINGTON",
    "PracticeLocationAddressStateName": "DE",
    "PracticeLocationAddressPostalCode": "19804-1825",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "302-299-2687",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/01/2026",
    "LastUpdateDate": "06/01/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "VERDEN",
    "AuthorizedOfficialFirstName": "MARIO",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CO-OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": "JR.",
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "302-299-2687",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "320800000X",
          "TaxonomyName": "Mental Illness Community Based Residential Treatment Facility",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251C00000X",
          "TaxonomyName": "Developmentally Disabled Services Day Training Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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