Provider Demographics
NPI:1154511699
Name:FORWARD LIVING LLC
Entity Type:Organization
Organization Name:FORWARD LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:LARON
Authorized Official - Last Name:BASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-820-4231
Mailing Address - Street 1:13107 HERRICK AVE
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-3548
Mailing Address - Country:US
Mailing Address - Phone:816-820-4231
Mailing Address - Fax:
Practice Address - Street 1:13107 HERRICK AVE
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-3548
Practice Address - Country:US
Practice Address - Phone:816-820-4231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services