Provider Demographics
NPI:1982340220
Name:ONE DIRECTION FORWARD INC.
Entity Type:Organization
Organization Name:ONE DIRECTION FORWARD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-300-6977
Mailing Address - Street 1:4747 LINCOLN MALL DR STE 412
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3821
Mailing Address - Country:US
Mailing Address - Phone:708-300-6977
Mailing Address - Fax:708-300-6978
Practice Address - Street 1:4747 LINCOLN MALL DR STE 412
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-3821
Practice Address - Country:US
Practice Address - Phone:708-300-6977
Practice Address - Fax:708-300-6978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1215392931Medicaid