Provider Demographics
NPI:1114167806
Name:FIRM FOUNDATION INC.
Entity Type:Organization
Organization Name:FIRM FOUNDATION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-263-1687
Mailing Address - Street 1:705 CUMBERLAND ST.
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-7020
Mailing Address - Country:US
Mailing Address - Phone:910-485-3332
Mailing Address - Fax:910-485-1453
Practice Address - Street 1:705 CUMBERLAND ST.
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-7020
Practice Address - Country:US
Practice Address - Phone:910-485-3332
Practice Address - Fax:910-485-1453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
1041C0700X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6006651Medicaid