Provider Demographics
NPI:1033652300
Name:NOT FORGOTTEN HOME AND COMMUNITY SERVICES
Entity Type:Organization
Organization Name:NOT FORGOTTEN HOME AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-330-7652
Mailing Address - Street 1:225 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-1927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:WEST MIFFLIN
Practice Address - State:PA
Practice Address - Zip Code:15122-1927
Practice Address - Country:US
Practice Address - Phone:412-330-7652
Practice Address - Fax:412-595-7379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN253222L164W00000X
PA251C00000X, 251E00000X, 251J00000X, 253Z00000X, 310400000X, 311500000X, 320900000X, 385H00000X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing Care
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1588117725Medicaid