Provider Demographics
NPI:1376390831
Name:FOUNDATIONS SUPPORTIVE CARE, LLC
Entity type:Organization
Organization Name:FOUNDATIONS SUPPORTIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONALDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-355-5805
Mailing Address - Street 1:2412 HARPOON DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-2521
Mailing Address - Country:US
Mailing Address - Phone:571-355-5805
Mailing Address - Fax:
Practice Address - Street 1:3501 CASTLE HILL DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5326
Practice Address - Country:US
Practice Address - Phone:571-355-5805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities