Provider Demographics
NPI:1841955242
Name:THE FORGE - HEALTH AND FITNESS GROUP LLC
Entity type:Organization
Organization Name:THE FORGE - HEALTH AND FITNESS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUKUNAGA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:808-551-8648
Mailing Address - Street 1:1520 WARD AVE APT 904
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-3556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:955 WAIMANU ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3319
Practice Address - Country:US
Practice Address - Phone:808-818-3433
Practice Address - Fax:808-427-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-02
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy