Basic Information
| Provider Information | |||||||||
| NPI: | 1720284219 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOLID FOUNDATION FACILITIES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 WARD RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279839074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527942385 | ||||||||
| FaxNumber: | 2527941923 | ||||||||
| Practice Location | |||||||||
| Address1: | 224 WARD RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279839074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527942385 | ||||||||
| FaxNumber: | 2527941923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 12/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | RODGERS | ||||||||
| AuthorizedOfficialFirstName: | R | ||||||||
| AuthorizedOfficialMiddleName: | VERNELL | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2527942385 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 8301328 | 05 | NC | MEDICAID | 8301328C | 05 | NC | MEDICAID |