Fathers Forever Coalition, Inc

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

FATHERS FOREVER COALITION, INC

Practice address

1129 16TH St
Bedford, IN 47421-3721

Phone

(812) 329-6941

Fax

(812) 675-8416

NPI assigned

Apr 11, 2022

Organization subpart

No

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

Authorized official

Name

Casey M Derossett

Title

Director of Wellness and Recovery

Phone

(812) 278-7590

Specialties & licenses 1

Addresses

Other names 1

• Families Forever Doing business as

Locations

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649635200000",
    "number": "1376285270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 16TH ST",
            "city": "BEDFORD",
            "state": "IN",
            "postal_code": "474213721",
            "telephone_number": "812-329-6941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 16TH ST",
            "city": "BEDFORD",
            "state": "IN",
            "postal_code": "474213721",
            "telephone_number": "812-329-6941",
            "fax_number": "812-675-8416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FATHERS FOREVER COALITION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-11",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "DEROSSETT",
        "authorized_official_first_name": "CASEY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR OF WELLNESS AND RECOVERY",
        "authorized_official_telephone_number": "812-278-7590"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Families Forever",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Substance Use Disorder Rehabilitation Clinic/Center in Bedford, IN
• Providers in Bedford, IN by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2022; 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.