=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689469447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOVING FORWARD TREATMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2025
-----------------------------------------------------
Last Update Date | 04/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 49 MONTECITO DR
-----------------------------------------------------
City | CORONA DEL MAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92625-1017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-745-0138
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 49 MONTECITO DR
-----------------------------------------------------
City | CORONA DEL MAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92625-1017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-745-0138
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/COO
-----------------------------------------------------
Name | MR. WILLIAM DAVIS BALBIRNIE
-----------------------------------------------------
Credential | CATC
-----------------------------------------------------
Telephone | 949-745-0138
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------