Provider Demographics
NPI:1679357107
Name:WILLING 2 MOVE FORWARD
Entity Type:Organization
Organization Name:WILLING 2 MOVE FORWARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MIRA TALBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-528-2139
Mailing Address - Street 1:1104 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3521
Mailing Address - Country:US
Mailing Address - Phone:562-528-2139
Mailing Address - Fax:
Practice Address - Street 1:1104 OLIVE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3521
Practice Address - Country:US
Practice Address - Phone:562-528-2139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodging
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty