Provider Demographics
NPI:1821207580
Name:FIRM FOUINDATIONS LLC
Entity Type:Organization
Organization Name:FIRM FOUINDATIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:208-251-7885
Mailing Address - Street 1:2496 MESA ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-3369
Mailing Address - Country:US
Mailing Address - Phone:208-251-7885
Mailing Address - Fax:208-745-0527
Practice Address - Street 1:2496 MESA ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-3369
Practice Address - Country:US
Practice Address - Phone:208-251-7885
Practice Address - Fax:208-745-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8068920Medicaid