Basic Information
| Provider Information | |||||||||
| NPI: | 1326245150 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FORTE | ||||||||
| FirstName: | TORSHIA | ||||||||
| MiddleName: | LADELL | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 251970 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722251970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5016668686 | ||||||||
| FaxNumber: | 5016606830 | ||||||||
| Practice Location | |||||||||
| Address1: | 511 STONEWALL SQ | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5019820518 | ||||||||
| FaxNumber: | 5019852220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.