Provider Demographics
NPI:1083478374
Name:FAITH FORWARD PSYCHIATRY LLC
Entity Type:Organization
Organization Name:FAITH FORWARD PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:715-222-5958
Mailing Address - Street 1:1429 MAGEE CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-5927
Mailing Address - Country:US
Mailing Address - Phone:715-222-5958
Mailing Address - Fax:
Practice Address - Street 1:7900 INTERNATIONAL DR STE 300-7007
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55425-1510
Practice Address - Country:US
Practice Address - Phone:715-222-5958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-07
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty