Provider Demographics
NPI:1558839761
Name:FOUNDATIONS OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:FOUNDATIONS OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MECHAC
Authorized Official - Middle Name:E
Authorized Official - Last Name:TRICE JONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-709-5570
Mailing Address - Street 1:999 W PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4634
Mailing Address - Country:US
Mailing Address - Phone:954-776-8036
Mailing Address - Fax:
Practice Address - Street 1:999 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-4634
Practice Address - Country:US
Practice Address - Phone:954-776-8036
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No343800000XTransportation ServicesSecured Medical Transport (VAN)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06-BID-3692692OtherSTATE OPERATING PERMIT
FL06-BID-3692692OtherSTATE OPERATIONS LICENSE