Provider Demographics
NPI:1629695606
Name:FALL FORWARD
Entity Type:Organization
Organization Name:FALL FORWARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:402-481-5597
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:NE
Mailing Address - Zip Code:68832-0105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:312 N ELM ST STE 115
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-4509
Practice Address - Country:US
Practice Address - Phone:402-481-5597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)