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
1	251S00000X	Community/Behavioral Health Agency
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1871016691
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	:	740-357-1937
Fax Number	:

Provider Business Practice Location Address
First Line	:	7175 STATE ROUTE 104
Second Line	:
City	:	MC DERMOTT
State	:	OH
Zip	:	45652-8888
Country	:	US
Telephone Number	:	740-858-6683
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELE LAWSON
Credential	:
Telephone Number	:	740-357-1937

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	12/15/2023

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Directions to “MOVING FORWARD RESIDENTIAL LLC ” Practice Location

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