Provider Demographics
NPI:1023899671
Name:FOUNDATIONS BOARD & LODGE LLC
Entity type:Organization
Organization Name:FOUNDATIONS BOARD & LODGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PSYCHOLOGIST, CLINICAL
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD, LPCC
Authorized Official - Phone:320-434-1312
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-0683
Mailing Address - Country:US
Mailing Address - Phone:320-434-8007
Mailing Address - Fax:651-925-0087
Practice Address - Street 1:1135 HIGHWAY 7 W
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-1511
Practice Address - Country:US
Practice Address - Phone:320-434-8007
Practice Address - Fax:651-925-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health