Provider Demographics
NPI:1669615761
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/PRESIDENT
Authorized Official - Prefix:MR
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:252-794-2433
Mailing Address - Fax:252-794-2394
Practice Address - Street 1:208 DUNDEE ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:NC
Practice Address - Zip Code:27983-6701
Practice Address - Country:US
Practice Address - Phone:252-794-2433
Practice Address - Fax:252-794-2394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300759RMedicaid