Provider Demographics
NPI:1689283186
Name:MOVING FORWARD DEVELOPMENTAL CENTER L L C
Entity type:Organization
Organization Name:MOVING FORWARD DEVELOPMENTAL CENTER L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEELAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-542-8929
Mailing Address - Street 1:210 S BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2955
Mailing Address - Country:US
Mailing Address - Phone:856-542-8929
Mailing Address - Fax:
Practice Address - Street 1:210 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2955
Practice Address - Country:US
Practice Address - Phone:856-542-8929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care