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NPI Code Detail

MEDICARE: MOVING FORWARD RESIDENTIAL LLC

MEDICARE: MOVING FORWARD RESIDENTIAL 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
1324500000XSubstance Abuse Rehabilitation Facility
2251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1811767684
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOVING FORWARD RESIDENTIAL LLC
Provider Business Mailing Address
First Line : PO BOX 402
Second Line :
City : WHEELERSBURG
State : OH
Zip : 45694-0402
Country : US
Telephone Number : 740-858-6683
Fax Number :
Provider Business Practice Location Address
First Line : 9620 CAREYS RUN POND CREEK RD
Second Line :
City : MC DERMOTT
State : OH
Zip : 45652-3902
Country : US
Telephone Number : 740-858-6683
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MICHELE LAWSON
Credential :
Telephone Number : 740-858-6683
Provider Enumeration Date : 01/03/2024
Last Update Date : 04/08/2024

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Directions to “MOVING FORWARD RESIDENTIAL LLC ” Practice Location

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