MEDICARE: MOVING FORWARD TREATMENT CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility

General Provider Information

NPI Number	:	1255263059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOVING FORWARD TREATMENT CENTER LLC

Provider Business Mailing Address
First Line	:	1652 AMBERCREST DR
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75146-4942
Country	:	US
Telephone Number	:	214-212-3842
Fax Number	:

Provider Business Practice Location Address
First Line	:	1034 CONDOR DR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75051-3349
Country	:	US
Telephone Number	:	214-212-3842
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. SARITA FONTAINE
Credential	:
Telephone Number	:	214-212-3842

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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