Provider Demographics
NPI:1578754438
Name:FOUNDATIONS PSYCHIATRIC REHABILITATION PROGRAM
Entity Type:Organization
Organization Name:FOUNDATIONS PSYCHIATRIC REHABILITATION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-789-7772
Mailing Address - Street 1:1025 W NURSERY RD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1205
Mailing Address - Country:US
Mailing Address - Phone:410-789-7772
Mailing Address - Fax:410-789-7177
Practice Address - Street 1:1025 W NURSERY RD
Practice Address - Street 2:SUITE 118
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-1205
Practice Address - Country:US
Practice Address - Phone:410-789-7772
Practice Address - Fax:410-789-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18660261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health