Provider Demographics
NPI:1093094641
Name:MOVING LIVES FORWARD
Entity Type:Organization
Organization Name:MOVING LIVES FORWARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRAINNEE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:ALVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-560-6243
Mailing Address - Street 1:38 DUDLEY AVE APT A
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2405
Mailing Address - Country:US
Mailing Address - Phone:310-560-6243
Mailing Address - Fax:
Practice Address - Street 1:38 DUDLEY AVE APT A
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2405
Practice Address - Country:US
Practice Address - Phone:310-560-6243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management