Provider Demographics
NPI:1578269270
Name:FORWARD, AMY P
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:P
Last Name:FORWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WASHBURN RD
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2612
Mailing Address - Country:US
Mailing Address - Phone:832-506-6648
Mailing Address - Fax:
Practice Address - Street 1:116 WASHBURN RD
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2612
Practice Address - Country:US
Practice Address - Phone:832-506-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHVP033967Medicaid