Fourth Plain Forward

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

FOURTH PLAIN FORWARD

Practice address

5107 E 4TH Plain Blvd Ste 111
Vancouver, WA 98661-8505

Phone

(971) 570-4999

NPI assigned

Jul 9, 2024

Organization subpart

No

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

Authorized official

Name

Wil Fuentes

Title

Program Manager

Phone

(971) 570-4999

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1720483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1215774229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5107 E 4TH PLAIN BLVD STE 111",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986618505",
            "telephone_number": "971-570-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5107 E 4TH PLAIN BLVD STE 111",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986618505",
            "telephone_number": "971-570-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOURTH PLAIN FORWARD",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-09",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "FUENTES",
        "authorized_official_first_name": "WIL",
        "authorized_official_title_or_position": "PROGRAM MANAGER",
        "authorized_official_telephone_number": "971-570-4999"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Community/Behavioral Health Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.