Provider Demographics
NPI:1073028924
Name:FOUNDATIONS THERAPY, LLC
Entity Type:Organization
Organization Name:FOUNDATIONS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ERINNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:DT
Authorized Official - Phone:309-989-7724
Mailing Address - Street 1:14255 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MANITO
Mailing Address - State:IL
Mailing Address - Zip Code:61546-8627
Mailing Address - Country:US
Mailing Address - Phone:309-989-7724
Mailing Address - Fax:
Practice Address - Street 1:14255 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:MANITO
Practice Address - State:IL
Practice Address - Zip Code:61546-8627
Practice Address - Country:US
Practice Address - Phone:309-989-7724
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILEH90471113P252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency