Provider Demographics
NPI:1255053336
Name:FORCES FOR CHANGE LLC
Entity type:Organization
Organization Name:FORCES FOR CHANGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDFORD-JACK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:860-966-6631
Mailing Address - Street 1:822 N SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-2211
Mailing Address - Country:US
Mailing Address - Phone:860-966-6631
Mailing Address - Fax:
Practice Address - Street 1:211 N WHITFIELD ST STE 300A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3039
Practice Address - Country:US
Practice Address - Phone:860-966-6631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health