Basic Information
Provider Information | |||||||||
NPI: | 1518162320 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SOLID FOUNDATION FACILITIES, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 224 WARD RD | ||||||||
Address2: |   | ||||||||
City: | WINDSOR | ||||||||
State: | NC | ||||||||
PostalCode: | 279839074 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2527942382 | ||||||||
FaxNumber: | 2527941923 | ||||||||
Practice Location | |||||||||
Address1: | 1313 1ST ST W | ||||||||
Address2: |   | ||||||||
City: | AHOSKIE | ||||||||
State: | NC | ||||||||
PostalCode: | 279108842 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2527942385 | ||||||||
FaxNumber: | 2527941923 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/20/2007 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RODGERS | ||||||||
AuthorizedOfficialFirstName: | R | ||||||||
AuthorizedOfficialMiddleName: | VERNELL | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 2527942385 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
ID Information
ID | Type | State | Issuer | Description | 8300760F | 05 | NC |   | MEDICAID | 8300760H | 05 | NC |   | MEDICAID | 8300760G | 05 | NC |   | MEDICAID | 8300760 | 05 | NC |   | MEDICAID | 8300760J | 05 | NC |   | MEDICAID | 8300760I | 05 | NC |   | MEDICAID | 8300760B | 05 | NC |   | MEDICAID |