Organization
MOVING FORWARD PEDIATRIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIKI SHEREE LOGAN (CEO)
(704) 466-4644
Entity
Organization
Contact information
Practice address
245 E PARK RD, ELLENBORO, NC 28040-7621
(704) 466-4644
(828) 589-0227
Mailing address
245 E PARK RD, ELLENBORO, NC 28040-7621
(704) 466-4644
(828) 589-0227
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
302F00000X
Exclusive Provider Organization
—
—
Other
Enumeration date
03/24/2017
Last updated
03/24/2017
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