=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578209417
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROJECT FORWARD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2022
-----------------------------------------------------
Last Update Date | 05/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 12TH ST N
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55371-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-482-1514
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1510 12TH ST N
-----------------------------------------------------
City | PRINCETON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55371-1013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 763-482-1514
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/ EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | JORDANAI ANNE TREUBER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 763-482-1514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 177F00000X
-----------------------------------------------------
Taxonomy Name | Lodging Provider
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 251V00000X
-----------------------------------------------------
Taxonomy Name | Voluntary or Charitable Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------