Provider Demographics
NPI:1851692719
Name:SOLID FOUNDATION FACILITIES INC
Entity Type:Organization
Organization Name:SOLID FOUNDATION FACILITIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:R
Authorized Official - Middle Name:VERNELL
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-794-2385
Mailing Address - Street 1:PO BOX 709
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:NC
Mailing Address - Zip Code:27983-0709
Mailing Address - Country:US
Mailing Address - Phone:252-794-2385
Mailing Address - Fax:252-794-4747
Practice Address - Street 1:1321 FIRST ST W
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-8842
Practice Address - Country:US
Practice Address - Phone:252-209-8932
Practice Address - Fax:252-209-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-09
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC626103T00000X, 1041C0700X, 251S00000X
NC251B00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8703090Medicaid
NC8300760HMedicaid
NC8302968SMedicaid
NC8302968DMedicaid
NC8300759VMedicaid