Provider Demographics
NPI:1376285270
Name:FATHERS FOREVER COALITION, INC
Entity Type:Organization
Organization Name:FATHERS FOREVER COALITION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF WELLNESS AND RECOVERY
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEROSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-278-7590
Mailing Address - Street 1:1129 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-3721
Mailing Address - Country:US
Mailing Address - Phone:812-329-6941
Mailing Address - Fax:
Practice Address - Street 1:1129 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3721
Practice Address - Country:US
Practice Address - Phone:812-329-6941
Practice Address - Fax:812-675-8416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder