Basic Information
| Provider Information | |||||||||
| NPI: | 1477054906 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOUNDATIONS RECOVERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10019 REISTERSTOWN RD FL 3 | ||||||||
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| City: | OWINGS MILLS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 211173902 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7131 RUTHERFORD RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR MILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212442702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104011970 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2018 | ||||||||
| LastUpdateDate: | 11/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | COSTLEY | ||||||||
| AuthorizedOfficialFirstName: | JESSIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | LICENSING AND CREDENTIALING SPECIAL | ||||||||
| AuthorizedOfficialTelephone: | 4108078471 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0405X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
No ID Information.