Basic Information
| Provider Information | |||||||||
| NPI: | 1851692719 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOLID FOUNDATION FACILITIES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 709 | ||||||||
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| City: | WINDSOR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279830709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527942385 | ||||||||
| FaxNumber: | 2527944747 | ||||||||
| Practice Location | |||||||||
| Address1: | 1321 FIRST ST W | ||||||||
| Address2: | |||||||||
| City: | AHOSKIE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 279108842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522098932 | ||||||||
| FaxNumber: | 2522098933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2010 | ||||||||
| LastUpdateDate: | 01/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | RODGERS | ||||||||
| AuthorizedOfficialFirstName: | R | ||||||||
| AuthorizedOfficialMiddleName: | VERNELL | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2527942385 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 626 | NC | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 251B00000X | NC | N | Agencies | Case Management | 251S00000X | 626 | NC | N | Agencies | Community/Behavioral Health | 253Z00000X | NC | N | Agencies | In Home Supportive Care | 103T00000X | 626 | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 8703090 | 05 | NC | MEDICAID | 8300760H | 05 | NC | MEDICAID | 8302968S | 05 | NC | MEDICAID | 8302968D | 05 | NC | MEDICAID | 8300759V | 05 | NC | MEDICAID |