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General NPI Number Information
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NPI Number | 1477724953
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Entity Type | Organization
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Legal Business Name | FORWARD LIVING INC.
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 03/12/2008
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Provider Practice Location Address
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Address Line | 1868 CURRENT ST
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City | LIBERTY
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State | MO
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Zip | 64068-8492
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Country | US
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Telephone | 816-820-4231
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Fax |
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Provider Business Mailing Address
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Address Line | 13107 HERRICK AVE
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City | GRANDVIEW
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State | MO
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Zip | 64030-3548
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Country | US
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Telephone | 816-820-4231
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Fax |
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Authorized Official
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Title or Position | QMRP
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Name | MRS. LINDA SUE BASTON
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Credential |
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Telephone | 816-820-4231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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