Provider Demographics
NPI:1528765864
Name:FORGE EVOLUTION
Entity type:Organization
Organization Name:FORGE EVOLUTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-475-7518
Mailing Address - Street 1:224 E KIOWA ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1707
Mailing Address - Country:US
Mailing Address - Phone:719-475-7815
Mailing Address - Fax:
Practice Address - Street 1:224 E KIOWA ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1707
Practice Address - Country:US
Practice Address - Phone:719-475-7815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No405300000XOther Service ProvidersPrevention ProfessionalGroup - Multi-Specialty