Provider Demographics
NPI:1164504395
Name:SOLID FOUNDATION FACILITIES INCORPORATED
Entity Type:Organization
Organization Name:SOLID FOUNDATION FACILITIES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:R.
Authorized Official - Middle Name:VERNELL
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-794-2385
Mailing Address - Street 1:PO BOX 709
Mailing Address - Street 2:224 WARD ROAD
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-0709
Mailing Address - Country:US
Mailing Address - Phone:252-794-2385
Mailing Address - Fax:252-794-1923
Practice Address - Street 1:208 DUNDEE ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-6701
Practice Address - Country:US
Practice Address - Phone:252-794-4800
Practice Address - Fax:252-794-4747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC626101YP2500X, 103T00000X, 1041C0700X, 106H00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408848Medicaid
NC5906030Medicaid
NC8300759BMedicaid
NC8300759HMedicaid
NC232104OtherMEDICARE PTAN
NC8300760Medicaid
NC8300760HMedicaid
NC6005687Medicaid