Provider Demographics
NPI:1215392931
Name:ONE DIRECTION FORWARD INC.
Entity Type:Organization
Organization Name:ONE DIRECTION FORWARD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MSW
Authorized Official - Phone:773-742-8053
Mailing Address - Street 1:4747 LINCOLN MALL DR STE 412
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3821
Mailing Address - Country:US
Mailing Address - Phone:708-300-6977
Mailing Address - Fax:
Practice Address - Street 1:4747 LINCOLN MALL DR STE 412
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-3821
Practice Address - Country:US
Practice Address - Phone:708-300-6977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-3826-0001-A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health