Organization
FOREVER CHANGED FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA VAUGHN RC (DIRECTOR)
(253) 282-0262
Entity
Organization
Contact information
Practice address
7804 YAKIMA AVE, TACOMA, WA 98408-5317
(253) 765-1713
Mailing address
7804 YAKIMA AVE, TACOMA, WA 98408-5317
(253) 765-1713
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073284204
—
WA
Enumeration date
11/08/2021
Last updated
11/08/2021
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