Provider Demographics
NPI:1942916903
Name:FOUNDATION STONE, LLC. DBA AMEND
Entity Type:Organization
Organization Name:FOUNDATION STONE, LLC. DBA AMEND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HALEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-502-2920
Mailing Address - Street 1:701 N HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-1021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 N HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-1021
Practice Address - Country:US
Practice Address - Phone:706-502-2920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherHHSC