Provider Demographics
NPI:1225787153
Name:FOUNDATIONS FOR SUCCESS, LLC
Entity Type:Organization
Organization Name:FOUNDATIONS FOR SUCCESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHAMIRAH
Authorized Official - Middle Name:NATARSHA
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:240-600-0942
Mailing Address - Street 1:367 MARYDELL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-4108
Mailing Address - Country:US
Mailing Address - Phone:240-600-0942
Mailing Address - Fax:
Practice Address - Street 1:367 MARYDELL RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4108
Practice Address - Country:US
Practice Address - Phone:240-600-0942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health