MEDICARE: MOVE N FORWARD 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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1275982035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOVE N FORWARD LLC

Provider Business Mailing Address
First Line	:	5546 CAMINO AL NORTE
Second Line	:	SUITE 2-257
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0805
Country	:	US
Telephone Number	:	702-478-4778
Fax Number	:	702-444-4779

Provider Business Practice Location Address
First Line	:	5546 CAMINO AL NORTE
Second Line	:	SUITE 2-257
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-0805
Country	:	US
Telephone Number	:	702-478-4778
Fax Number	:	702-444-4779

Authorized Official
Title or Position	:	OWNER
Name	:	NATASHA MOENIQUE MCQUEEN
Credential	:
Telephone Number	:	702-478-4778

Provider Enumeration Date	:	06/11/2016
Last Update Date	:	10/17/2016

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Directions to “MOVE N FORWARD LLC ” Practice Location

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