Provider Demographics
NPI:1912179888
Name:FOUNDATION STRONG, LLC
Entity Type:Organization
Organization Name:FOUNDATION STRONG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:DEBERRY
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-508-2847
Mailing Address - Street 1:PO BOX 77805
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27417-7805
Mailing Address - Country:US
Mailing Address - Phone:336-307-3198
Mailing Address - Fax:336-307-3906
Practice Address - Street 1:1677 BANBRIDGE RD
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-4363
Practice Address - Country:US
Practice Address - Phone:336-307-3198
Practice Address - Fax:336-307-3906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness