Provider Demographics
NPI:1225647787
Name:FOUNDATIONS FOR SENIORS, INC
Entity Type:Organization
Organization Name:FOUNDATIONS FOR SENIORS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:FELICHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-910-0390
Mailing Address - Street 1:1598 FALKLAND RD E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-2803
Mailing Address - Country:US
Mailing Address - Phone:904-910-0390
Mailing Address - Fax:904-683-4975
Practice Address - Street 1:1598 FALKLAND RD E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-2803
Practice Address - Country:US
Practice Address - Phone:904-910-0390
Practice Address - Fax:904-683-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106688700Medicaid