Malia-Rose Nicole Forbis, PEER SUPPORT SPEC

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

Practice address

3878 Beverly Ave NE BLDG H
Salem, OR 97305-1394

Phone

(503) 576-4584

NPI assigned

Aug 21, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1345507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553126400000",
    "number": "1124376298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "379 KNOX ST N APT 1",
            "city": "MONMOUTH",
            "state": "OR",
            "postal_code": "973611400",
            "telephone_number": "503-899-5660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3878 BEVERLY AVE NE BLDG H",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973051394",
            "telephone_number": "503-576-4584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORBIS",
        "first_name": "MALIA-ROSE",
        "middle_name": "NICOLE",
        "name_prefix": "Miss",
        "credential": "PEER SUPPORT SPEC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-21",
        "last_updated": "2019-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "OR",
            "license": "A4730",
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Albert Folsom
• Kylie Maran Fonteno, PA-C
• Foothills Medical Supply, LLC
• Emma Marie Forbes, DPT
• Leilnai Forbis
• Alexander Ian Force
• Julie Ford
• John Eric Fordyce
• Forefront Telecare PC
• Carl W Foreman

• Community Health Worker in Salem, OR
• Providers in Salem, OR by specialty
• Community Health Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.